Your stem cell transplant consultation: Questions to ask
January 31, 2025
Medically Reviewed | Last reviewed by Amin Alousi, M.D., on January 31, 2025
Your doctor may recommend that you undergo a stem cell transplant if you’ve been diagnosed with a blood cancer, such as leukemia, lymphoma, multiple myeloma or myelodysplastic syndrome — or even a bone marrow failure syndrome such as aplastic anemia.
This procedure replaces blood cells that have been damaged by cancer or chemotherapy with healthy cells. But before you move forward with a stem cell transplant, you’ll need to consult a specialist. We talked with stem cell specialist Amin Alousi, M.D., about the best questions to ask to ensure that you feel comfortable with this procedure.
What type of stem cell transplant do you recommend for me?
There are several types of stem cell transplants. The one you need will depend on what kind of disease you have and how advanced it is.
But all stem cell transplants fall into two categories:
- An autologous stem cell transplant uses the patient’s own cells
- An allogenic stem cell transplant uses cells from a donor.
Patients with multiple myeloma or lymphoma tend to receive autologous transplants, while leukemia patients tend to receive allogeneic transplants.
How will you find a donor for me?
If you need an allogeneic transplant, we’ll start by looking for possible donors among your siblings. If we can’t find a match among those, we’ll start looking at other family members, such as your parents and sometimes even your children.
We’ll need you to mention any conditions they might have, such as cancer or heart problems, or any habits like drug use that could preclude them from being a suitable donor. So, be prepared to discuss their medical histories.
If a related donor isn’t a possibility, there are still other options, such as an unrelated donor found through the National Marrow Donor Program or an umbilical cord blood transplant.
Will I need other types of treatment before or after the transplant?
Yes. A stem cell transplant is just one part of a three-phase plan.
Before the transplant, you’ll receive chemotherapy and/or radiation therapy to kill the cancer and suppress your immune system to allow the donor stem cells to grow.
After the transplant, you might also need low-dose chemotherapy as a maintenance treatment. Most myeloma patients are on some sort of maintenance treatment for years.
What risks are associated with a stem cell transplant?
Stem cell transplants have successfully cured many cancer patients. But as with any medical procedure, there are some risks. Some of them can be life-threatening, so it's important to discuss them all with your doctor. That way, you'll know what to look for. Risks include:
- side effects from the conditioning chemotherapy
- graft vs. host disease (GVHD)
- infections
But keep in mind that we have significantly increased the safety of stem cell transplants over the past 20 years, so these procedures are now safer than ever.
What exactly is graft vs. host disease?
That’s when a donor’s cells recognize a patient’s tissues as foreign and attack them. Symptoms can be mild, such as a rash or loss of appetite, or severe, such as diarrhea or jaundice.
Graft vs. host disease can be life-threatening, but early detection and intervention will reduce the risk of long-term effects. It’s important to be familiar with the signs so that you can seek care quickly. To lower the risk, we give patients immunosuppressive medications.
How long will I be in the hospital for my stem cell transplant?
That depends on the type you receive. But in general, you should plan to be in the hospital for three to four weeks.
Some phases of allogeneic transplants can now be done as outpatient procedures, because we’ve increased the safety of the procedures so much. Patients used to have to be hospitalized for the conditioning chemotherapy regimen, for instance. Today, we can administer more of that on an outpatient basis, so some patients just get admitted the day before the transplant. It really reduces the amount of time they have to spend in the hospital.
What will my life look like after I leave the hospital?
You’ll need to stay in close proximity to the hospital (typically within a 30-45 minute drive radius) for roughly three months following an allogeneic transplant and 2-4 weeks if your own stem cells are used.
During this period, you will be seen frequently to ensure that you are recovering well from the transplant and to quickly identify complications (such as infections or graft-versus-host disease). There are many factors we have to watch very closely, to make sure your donor cells are engrafting properly and growing well. We’ll also need to monitor you carefully for infections, and adjust your medications, if necessary.
You should expect to return to the clinic daily at first, then maybe two or three times a week, and after Day 100, every two to three months.
This is an important process, so don’t skip any visits and make sure to take your medications as prescribed. Because while you may be feeling OK, your blood counts are still normalizing and your immune system is weak. That’s why you’ll need to receive the same immunizations you did as a child about six months to a year after the transplant. Your entire immune system has been reset. You’ll also need to be cautious about exposing yourself to germs.
Is there anything else I should know about stem cell transplants?
Asking questions is one of the best ways to involve yourself in the decision-making process and enhance your quality of life. So, write yours down in advance. That way, you won’t forget any during your consultation. It’s also a good idea to bring a friend or family member along to take notes. You can always ask them to refresh your memory later, so you can make informed decisions.
Request an appointment at MD Anderson online or call 1-877-632-6789.
These procedures are now safer than ever.
Amin Alousi, M.D.
Physician