Blood Stem Cell and Bone Marrow Transplant Procedure

May 6, 2024 
This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., Hematologist and Medical Director of Hematology and Blood and Bone Marrow Transplant, City of Hope Atlanta

A blood stem cell and bone marrow transplant is used to treat certain cancers, including lymphoma and leukemia, by replacing the diseased bone marrow with healthy cells, either from the patient’s body or from a donor.

It is a complex medical procedure that takes place in multiple steps over several weeks, so it’s important that patients have their treatment done at a center with bone marrow transplant experts.

This guide is designed to assist patients and their families in learning more about the bone marrow and stem cell transplant procedure.

How Is a Bone Marrow Transplant Done?

The process may vary based on the type of bone marrow transplant being performed. The main types of transplants are detailed below.

Autologous transplant: Autologous transplant (“auto” refers to “self”) is a procedure in which the patient’s own stem cells are removed before radiation therapy or chemotherapy is administered. After treatment, the stem cells are returned to the body to make normal blood cells.

Allogeneic transplant: In an allogeneic transplant (“allo” refers to “other”), stem cells are taken from a donor and placed into the body to make new blood cells. A stem cell or bone marrow transplant donor must be a good genetic match to the patient. Donor cells may come from a family member or the donor registry.

Haploidentical transplant: A haploidentical transplant uses donor cells that are a partial, but not exact, genetic match. They may come from a parent, child or sibling, and the donor is usually related. This transplant type requires additional steps to reduce the risk of complications.

Bone Marrow Transplant Preparation

Because a bone marrow transplant is a complex and time-consuming procedure that may involve hospital stays, much care is taken to prepare patients, both physically and mentally.

Before the transplant, several medical tests may be performed to assess patient health and eligibility for the procedure. These tests may include:

• Blood tests and physical examination
• Bone marrow biopsy
• Psychological evaluation and discussions to ensure patients will have a support system in place post-transplant
• Computed tomography (CT) or magnetic resonance imaging (MRI) scans
• Heart and lung function tests

Some patients may also have an additional procedure done as part of their preparation: the insertion of a central venous catheter (CVC) into a vein in the chest. This is an outpatient procedure, and the CVC will be used throughout the transplant process to administer medication or draw blood.

Patients should use the preparation period prior to the transplant to ask questions of their medical team and ensure they’re fully prepared.

How Is Bone Marrow Extracted?

Bone marrow is extracted under general anesthesia. Patients shouldn’t feel discomfort during the procedure. It’s most often collected from the pelvic bones, as they contain large amounts of stem cells.

Using a large needle inserted via the lower back, the physician collects liquid bone marrow, which is filtered and then frozen until needed.

This procedure is repeated until enough marrow has been collected.

Bone Marrow Conditioning

Prior to the transplant, patients undergo bone marrow conditioning, also known as pre-transplant treatment or bone marrow preparation.

Conditioning is a treatment of high-dose or reduced intensity chemotherapy and/or radiation therapy, but the exact treatments used will vary from patient to patient.

Bone marrow conditioning is performed for several reasons:

• It helps to destroy any cancer cells still in the body.
• It creates more room in the bone marrow for the stem cells that are about to be transplanted.
• It aids in immune system suppression, which may reduce the chance of the transplant cells being rejected.

Conditioning may take one to two weeks and may cause discomfort, due to the high doses given. The medical team will let patients know what to expect regarding recovery and potential side effects.

The Transplant Procedure

After conditioning, stem cells are infused into the body during the transplant procedure. This is performed via the central venous catheter in a similar manner to a blood transfusion. If the stem cells used were previously frozen, they’ll first be thawed and the patient may first receive medication to reduce any reaction to the preservatives used in the freezing process.

If the stem cells are coming from a donor, they may be collected from the donor, processed and then transplanted right after to the patient.

Bone Marrow Transplant Timeline

Due to the complexity of the bone marrow transplant procedure, the process takes place over several weeks or months. While the length of time may vary from patient to patient, below is an approximate timeline as to how long each part of the procedure may take.

Conditioning treatment: Conditioning may take one to two weeks, and it may be followed by a few days of rest.

Stem cell infusion: The transplant infusion procedure occurs on a single day.

Recovery period and engraftment: During the recovery period, which may take two to six weeks, the patient will be in the hospital or will visit the treatment center every day. During this time, engraftment should occur, which is when the stem cells begin to grow and multiply, creating new, healthy cells.

Ongoing rehabilitation: After being discharged from the hospital, rehabilitation and recovery may take up to a year, with patients tested regularly and monitored for any issues that may arise.

Is Bone Marrow Transplant Painful?

The actual infusion process of a bone marrow transplant is not painful. The patient will be awake during the procedure and won’t typically feel discomfort.

During the stem cell collection process, the patient or donor may feel soreness or discomfort or notice bruising for a few days after the procedure, but this may be managed with rest and over-the-counter pain medication.

Bone Marrow Transplant Recovery

The bone marrow transplant recovery process may be lengthy, as it takes several weeks for the transfused cells to engraft in the body. As white and red blood cell counts will be low after the transplant, patients are monitored very closely for side effects and are given antibiotics to prevent infection. It’s also important to help prevent infections by practicing good oral and mouth care, washing hands frequently and eating properly cooked meals.

Once discharged from the hospital, it may take up to six months for the body’s immune system and cell counts to recover. Patients may feel tired and weak and experience emotional changes during this time, so having the support of friends or family is essential during recovery.

Bone Marrow Transplant Side Effects

Immediately following allogeneic transplantation, patients are immunosuppressed and unable to fight infection. Different drugs are administered during this critical period, and the patient may need to be isolated.

Another possible complication for patients receiving allogeneic transplantation is known as graft-versus-host disease (GVHD). Despite the close match between patient and donor, in GVHD, the donated marrow may recognize its new home as foreign and react against the host.

In addition, patients may acquire post-transplant cytomegalovirus (CMV) pneumonia. City of Hope^® has pioneered several outstanding advances to prevent and treat this potentially fatal complication. Recurrent disease is also possible if the pre-transplant chemotherapy and radiation therapy are not successful in destroying all malignant cells.

In autologous transplantations, there are few complications once the patient leaves the hospital, and the only risk is whether the disease will return, causing relapse.

General side effects associated with stem cell and bone marrow transplant infusions may include:

• Shortness of breath
• Chills or fever
• Chest tightness or chest pain
• Low blood pressure
• Coughing
• Weakness
• Hives
• Reduced urination

If at any point in the recovery process patients notice unexplained changes to their body, it’s important for them to contact their care team for guidance.