Stem Cell Transplant — Procedure Guide, Recovery & Risks | MyMedicPlus

Name: Stem Cell Transplant
Published: 2026-06-26

Updated: 2026-06-26

Quick Facts

Type

Haematology / Oncology

Duration

3-6 weeks (inpatient)

Anaesthesia

None (IV infusion)

Hospital Stay

3-6 weeks

Recovery Time

6-12 months

What Is a Stem Cell Transplant?

Hematopoietic stem cell transplant (HSCT) infuses blood-forming stem cells after high-dose chemotherapy (conditioning) eliminates diseased marrow. Autologous SCT uses the patient's own cells (harvested before conditioning); allogeneic SCT uses cells from a matched sibling, unrelated donor, or umbilical cord blood.

Who Needs This Procedure?

Autologous SCT is used for multiple myeloma, Hodgkin and non-Hodgkin lymphoma, and testicular cancer. Allogeneic SCT treats acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), aplastic anemia, myelodysplastic syndrome, and thalassemia major.

How the Procedure Is Performed

Conditioning chemotherapy (and total body irradiation in some protocols) given over 5-7 days destroys existing marrow and immunosuppresses the recipient. Stem cells harvested from peripheral blood (G-CSF mobilized), bone marrow, or cord blood are infused intravenously. Engraftment occurs in 14-28 days when donor neutrophils exceed 0.5 x 10^9/L for three consecutive days.

Recovery & Aftercare

Neutropenic phase lasts 2-4 weeks; patients are isolated in HEPA-filtered rooms on prophylactic antibiotics, antivirals, and antifungals. Discharge occurs after engraftment, typically 3-6 weeks post-transplant. Immune reconstitution takes 12-24 months. Lifelong follow-up monitors for relapse, late organ toxicity, and secondary malignancy.

Risks & Complications

Allogeneic SCT carries graft-versus-host disease (GVHD) risk: acute GVHD (40-60%), chronic GVHD (30-50%). Other major risks: graft failure, veno-occlusive disease (sinusoidal obstruction syndrome), CMV and fungal infections, interstitial pneumonitis, and secondary malignancies years later. Autologous SCT avoids GVHD but has higher relapse risk.

Results & Success Rates

Autologous SCT achieves 5-year overall survival of 40-60% in multiple myeloma. Allogeneic SCT cures AML in first complete remission in 40-60% of patients, exploiting a graft-versus-leukemia (GVL) effect. Reduced-intensity conditioning (RIC) extends transplant eligibility to patients over 60 with comorbidities.

Frequently Asked Questions

Autologous SCT uses the patient's own stem cells collected before conditioning; it carries no GVHD risk and is less toxic but has no graft-versus-leukemia effect. Allogeneic SCT uses donor cells; it can cure leukemia through GVL but carries risks of GVHD, graft failure, and donor-derived infection. Choice depends on disease type, remission status, and patient fitness.

GVHD occurs when donor immune cells (T-lymphocytes) recognize recipient tissues as foreign and attack them. Acute GVHD (within 100 days) affects the skin, gut, and liver. Chronic GVHD resembles autoimmune disease and affects multiple organs. It is managed with immunosuppression (corticosteroids, calcineurin inhibitors, ruxolitinib, ibrutinib) but remains the leading cause of non-relapse mortality.

Peripheral blood stem cells are most commonly collected by apheresis after 4-5 days of G-CSF injections that mobilize cells from the bone marrow into the bloodstream. Bone marrow harvest under general anaesthesia collects 1-1.5 litres of marrow from the posterior iliac crests. Cord blood units are collected at birth and stored in public or private banks.

RIC (mini-transplant) uses lower-dose chemotherapy that is less myeloablative but still immunosuppressive enough to allow donor engraftment. It reduces early toxicity and treatment-related mortality, extending eligibility to older patients (60-75) and those with organ impairment. GVL effect is preserved; however, relapse rates may be slightly higher than myeloablative conditioning.

References

Copelan EA. Hematopoietic Stem-Cell Transplantation. NEJM. 2006.
EBMT/EHA — Handbook of Stem Cell Transplantation, 6th ed. 2024
NCCN Clinical Practice Guidelines — Hematopoietic Cell Transplantation, 2025

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