A stem cell transplant can be a life-saving procedure for someone with blood cancer. But there are a lot of myths about who needs a transplant, what it involves and who can be a donor.
Associate Professor James Morton became interested in transplants in the early 1990s and now specialises in haematology and stem cell transplantation. He recently sat down with the host of our Talking Blood Cancer Podcast to share his experiences and help debunk some common stem cell transplant myths.
Myth 1: A stem cell transplant and a bone marrow transplant are different things
Stem cells live in your bone marrow and have the ability to divide and grow into different types of blood cells. The stem cells can be collected from a donor and transplanted into a blood cancer patient as part of life-saving treatment.
There are three different types of stem cell transplants used to treat blood cancer:
- A peripheral blood stem cell transplant – the donor is given medications to help their stem cells leave the bone marrow and enter the bloodstream. A line is then inserted into the donor’s veins to collect the cells.
- A bone marrow transplant – stem cells are collected directly from the donor’s bone marrow.
- A cord blood transplant – stem cells are collected from the umbilical cord blood after a baby is born.
All these transplants use bone marrow stem cells, but the cells are collected in different ways. This means a bone marrow transplant is also a stem cell transplant.
Learn more about stem cell transplants.
Myth 2: You’ll need a stem cell transplant if you have leukaemia
Everyone’s blood cancer experience is different and not every person will need a stem cell transplant.
A/Prof Morton says your treatment team will consider a number of factors before recommending a transplant.
“When we see a patient for a transplant we’re looking at the disease they have, what are the chances that it can be cured, what are the chances that it will relapse, and what are the chances they’ll have an adverse outcome from the transplant,” A/Prof Morton says
“We take all those variables together to determine the best recommendation for that person in terms of the timing of the transplant. Is it a now thing? Or is it better off to see if we can fix their leukaemia with treatment and defer the risks of a transplant?”
Many types of blood cancer can be treated with a stem cell transplant including lymphoma, myeloma, myelodysplastic neoplasms, amyloidosis and aplastic aneamia.
Myth 3: Only young people are eligible for a transplant
A/Prof Morton says transplants initially required patients to be less than 40 to 45 years old, but the age limit is now much higher.
“We’re now transplanting, very successfully, people who are 70 or 75 and sometimes even older,” he says.
Doctors will consider your age along with other factors like fitness level, organ function and history of infections before recommending a transplant.
Learn more about our emotional, transport, accommodation and other support services for people going through treatment.
Myth 4: Donor cells must come from a blood relative
Early transplants relied on siblings to donate their stem cells because they were close genetic matches to the person with blood cancer.
Thankfully, as treatments improved, the number of people who could become donors also expanded. This list now includes:
- Blood relatives including siblings, parents or children
- Unrelated donors
- The patient (for an autologous stem cell transplant)
“We’re much better off having a young donor than an old donor,” A/Prof Morton says.
“And there may be subtle differences in outcome with different donor choices. But the outcomes are pretty similar now whether you have a brother or sister; a matched, unrelated donor; a mismatched, unrelated donor; or a half-matched family member.
“That essentially means we have much greater options for our patients who need a transplant.”
Find out more about donating your stem cells to a relative.
Myth 5: Making a donation is painful and involves taking a chunk of bone out of your hip
Most stem cells transplants involve collecting cells from a donor’s bloodstream (peripheral blood stem cell donation). Bone marrow collections are far less common (around 10% of the total number of transplants) because they are more invasive for the donor.
If someone is making a peripheral blood stem cell donation, they will receive injections for several days to increase the number of stem cells in their blood. On the day of their donation, they will be in hospital for four to six hours as an outpatient and can usually go home the same day.
A bone marrow collection involves taking stem cells from the donor’s pelvis. This occurs while they are under anaesthetic to ensure they don’t feel pain during the procedure. The donor may experience some discomfort and bruising afterwards and their body will usually replace their bone marrow within four weeks.
Learn more about the stem cell donation process.
Myth 6: The day of your transplant will be a “big event” and you’ll have to be isolated
You won’t need to be isolated in the lead-up to a transplant, but patients are advised to be particularly cautious with their health, avoid crowds and wear a mask in the month beforehand. This will help you stay as healthy as possible.
Although the transplant may save your life, many people are surprised by how uneventful the procedure is.
On the day of your transplant, you’ll sit in a hospital chair or lie on a bed. Nurses will hook up bags containing the donor stem cells to your intravenous line and it will be transfused into your body. This will usually take 30 to 60 minutes (sometimes the procedure will be longer).
You’ll then be admitted to hospital for four to six weeks and closely monitored while the stem cells travel to your bone marrow. If all goes well, you’ll then be discharged and will frequently return to the hospital outpatient clinic for several weeks as you continue to recover.
Although you’ll need to be careful and take precautions to protect yourself from infections following the transplant, you won’t have to be isolated from family and friends.
Our Blood Cancer Centres provide accommodation for people who have to travel far from home and stay close to their hospital for many months. If you’d like to become one of our incredible supporters and help people with blood cancer when they need it the most, donate here.
Myth 7: Your body may reject the donated cells
“When we have a lung, or a heart, or a kidney transplant, we’re worried about the person rejecting the new organ,” A/Prof Morton says.
“However, when we have a bone marrow transplant, it’s the other way round. We’re worrying about the new organ, which is the new bone marrow [stem cells], rejecting the patient.
“That’s because when you have a transplant of bone marrow, you also acquire that person’s immune system. And that immune system, when it starts growing inside you, can recognise you as foreign and attack you. That’s called graft versus host disease (GvHD).”
The disease can affect various parts of your body including the skin, mouth, eyes, lungs, gut (stomach and bowel), liver and other organs. Around 25% of people will develop GvHD and treatment may include additional medications to suppress the new immune system. While GvHD usually has significant negative impacts, the graft can provide some benefits.
“If people get a bit of GvHD, there is a reduced risk of their blood cancer returning,” A/Prof Morton says.
This article shares general information only. For tailored advice, please consult a healthcare professional.
Listen to the full interview with Associate Professor James Morton on our Talking Blood Cancer Podcast.
