Overview of Cord Blood Transplants
Stem cell transplants are increasingly being used as a method to treat a variety of diseases, mainly leukemia, lymphoma and myeloma. Stem cell transplants can use either cord blood stem cells or bone marrow stem cells and consist of the following stages: preparation, transplant procedure and recovery period. This guide provides an overview of the stages of cord blood transplants.
Cord Blood Transplants: Preparatory Regimen
Also known as the conditioning regimen, the preparatory stage of cord blood transplants involves high doses of chemotherapy and in some cases radiation treatment, which is used to treat the whole body in a process known as total body irradiation (TBI). The treatment dose is higher compared to patients who are not undergoing a cord blood transplant.
High doses are used in order to destroy diseased cells as well as to allow the development of new cell growth. A high intensity preparatory regimen also enables the suppression of the immune system, which is important since it prevents the body from attacking the transplanted cells.
The preparatory stage of cord blood transplants ranges from 4 to 10 days, depending on the patient's age, the nature of the disease (including whether the disease is active), as well as whether the patient has undergone any previous treatments. Preparation for the transplant can begin prior to the patient's admission to the hospital for transplant.
A single TBI can last between 10 to 20 minutes, and can take place during one day or else be spread out over a period of 7 days, depending on the dose.
Common side effects of this regimen include nausea, vomiting, diarrhea and decreased appetite.
Cord Blood Transplants: Transplant Procedure
The cord blood transplant procedure is performed one to two days after preparation for the transplant has been completed.
Also known as "Day Zero," it is common for the patient to feel fatigued and to still be experiencing symptoms of the preparatory regimen.
If the stem cells being used for the cord blood transplant procedure are from an adult donor, the donation will be completed on the day of the transplant. However, if umbilical cord stem cells are being used, they will be transferred to the transplant center prior to the transplant procedure.
Stem cells are stored in blood bags and their appearance (color and fluid amount) will vary depending on whether the cells are derived from bone marrow, umbilical cord or peripheral blood, and whether or not the cells have been filtered.
During the transplant procedure, the cells are infused (transmitted into the body) using an IV line, similar to a blood transfusion process. This is usually fed through a central line - that is, a tube surgically implanted into the vein in the chest.
The transplant procedure usually lasts one hour and is generally painless. A nurse monitors the patient's pulse as well as blood pressure. During the procedure, the patient is awake, but a mild sedative might be administered.
After the transplant, the donated cells move through the bloodstream and settle in the bone marrow. They begin to produce red and white blood cells as well as platelets, a procedure that is known as engraftment.
Cord Blood Transplants: Recovery
After engraftment occurs, the patient's blood cell count will continue to rise, resulting in increased immune system strength. However, the patient's immune system will be weaker than average for several months following a cord blood transplant.
While still in the hospital, the patient's body temperature will be taken four times a day, as fever is an indicator of infection. The patient will usually be given antibiotics and will be monitored for pneumonia. Blood tests will also be performed in order to evaluate the patient's recovery and monitor potential complications, including Graft-Versus-Host-Disease (GVHD) or graft failure (a rare condition that occurs in less than 5% of cases).
Sometime within 100 days after the transplant, the patient will generally be released from the hospital so as to begin treatment as an outpatient. Because different transplant centers have different recovery plans, a patient's release date will also differ.
Because outpatient care for a cord blood transplant can require daily checkups, it can be beneficial for the patient to choose a transplant center that is close to the patient's home.
After leaving the hospital, the patient should follow certain special care instructions in order to ensure proper recovery. This care includes getting an adequate amount of rest and following a healthy diet. This is because the individual is more prone to infection at this time, which can appear at the mouth, in the lungs, or in the urinary tract, for example.