Having a bone marrow transplant or stem cell transplant means doctors can give you a higher dose of chemotherapy. The aim of high-dose chemo is to create the best possible chance of killing off cancer cells in your body – and giving you stem cells or bone marrow via a transplant afterwards means your body can start creating healthy blood cells again after the chemo.
High-dose chemo usually takes five or six days – sometimes less, sometimes more. You might also have radiotherapy to kill any remaining cancer cells. Your bone marrow or stem cell transplant takes place afterwards.
Bone marrow basics
Before a bone marrow transplant, bone marrow is taken from a donor. The healthy bone marrow needs to closely match yours, so is usually taken from a close relative – like a brother or sister. This is done under general anaesthetic, and does take a while to recover from. Once you’ve had high-dose chemo, the donated bone marrow is given to you using a drip.
Stem cell basics
Stem cells for a transplant are usually collected from you, but can be collected from someone whose cells closely match yours – normally, but not always, a relative. Stem cells can be collected from your bone marrow or from blood. If your own cells are being collected, drips are attached to both of your arms. Blood is taken from one arm, filtered through a machine to collect stem cells, and then pumped back into your other arm. The cells are then frozen and given to you, via a drip, after your chemo.
What will it do?
High-dose chemo is more likely to kill cancer cells, but will also damage more of your bone marrow (the stuff inside your bones that makes blood cells) and your stem cells (the cells, made by your bone marrow, that develop into blood cells). So you’re given a transplant of bone marrow or stem cells to replace what’s destroyed by the chemo.
Chemo is a drug treatment and works by attacking and destroying the cells that cause cancer. You can read more about this in our chemotherapy section.
What happens next?
Having a stem cell transplant lowers your blood cell levels and affects your immune system, which means you're at a greater risk of picking up infections. So when you're admitted for your chemo and transplant, you'll be moved to a single room in the hospital for a few weeks – where there's less chance of getting ill.
This can feel pretty boring. You can usually have visitors, but often only one or two a day. There are things you can do to make your room feel more like home, though – put up photos, get people to write funny messages in a visitor book, bring in things you usually have in your bedroom. And always remember the three magic words – DVD box sets.
Any side effects?
Having a bone marrow transplant or stem cell transplant can have side effects – but most of these are caused by the high-dose chemo, rather than the actual transplant. Potential side effects include:
Infections and immune system. The chemo reduces your white blood cell count and immune system, increasing the risk of infection. Your nurses will let you know about food to avoid or be careful with. You’ll need to make sure you shower every day and have your sheets changed and room cleaned daily too. And if your visitors aren’t feeling well, they’ll need to stay away for a couple of days to reduce the chance of you getting ill.
Anaemia. Caused by a drop in red blood cells, anaemia leaves you feeling wiped out – short of energy and short of breath. Your nurse will keep an eye on your red cell count. If it’s low, a blood transfusion will give you an instant boost. Some people do react to blood transfusions, though, so if you feel hot, shivery or itchy while it’s happening, let your nurse know.
Bleeding. High-dose chemo kills more of the platelets that help your blood to clot, so you might notice blood when you’re not expecting it. If you see blood when you go to the loo, or if you have a nosebleed, bleeding gums, bruises or red spots on your skin, let your nurses know. You might need to have a platelet transfusion, given to you through a drip.
Infertility. It’s not usually possible to have children after having high-dose chemo. So while having kids might be the last thing on your mind right now, it’s still a good idea to chat through your options with doctors before starting treatment.
If you’re male, you might be able to store sperm so it can be used in the future. If you’re female, you might be able to store your eggs or take drugs to protect them. You might feel a bit weird bringing this up, but your doctor won’t think it’s weird at all – and you might be glad you did in a few years’ time.
Find out more about fertility.
If you have a transplant from another person, immune cells from the donor cells you’ve been given can sometimes attack your own cells – this is known as Graft versus host disease (GvHD). The new cells get confused, think your cells are infected cells, and attack them.
GvHD can start soon after a transplant or several months later. If it starts within three months, symptoms can include red spots on your skin, a high temperature, watery diarrhoea, stomach cramps and jaundice.
If it starts after three months, you might get an itchy rash, skin that feels hard, a dry mouth or dry eyes, or hair falling out. Chronic GvHD can affect any of your organs, so let your doctors know if you have these or any other symptoms.
Other chemo effects
You can read about common chemo side effects in our chemotherapy section. But some of the main ones include diarrhoea, sickness, having a sore mouth, not wanting to eat or drink, and feeling really tired. They can be pretty unpleasant – but should start to pass once the levels of blood cells in your blood get closer to normal.
Questions to ask
Never be afraid to ask questions about your cancer. Ask, ask and ask again. And if you don’t understand the answers you get, keep asking until you do.
If your doctor recommends a transplant, you might like to ask:
- Why a transplant is being recommended
- Whether you need chemo and radiotherapy
- What the side effects might be, and how you can reduce them
- How effective the transplant is likely to be
- How long you’ll be in hospital
- Whether you’ll be able to have kids after your transplant
- Whether any other treatments might work.