Transplant Phase
Transplant of Stem Cell Product:
Day zero is considered the day the Hematopoietic Stem Cells (HSCs) are transplanted.
Patient enters a HEPA (high-efficiency particulate air) filtered positive pressure isolation room to avoid contact with infectious agents (particularly airborne fungi such as Aspergillus and viruses).
The stem cells may be processed before infusion:
- Depletion of T cells can be performed to decrease GVHD
- Often done before haplotype-matched transplants or other transplants associated with significant degree of mismatch.
- Stem cell CD34 selection may be performed, either for depletion of T cells or for tumor-purging purposes.
Many centers are investigating ex vivo expansion of a portion of the cells before transplant in order to improve engraftment.
Before infusion, the patient is premedicated with acetaminophen and diphenhydramine to prevent reaction.
Bone marrow and peripheral blood HSCs are given like a blood transfusion into a central vein over 3-4 hours. HSCs first enter the circulation and then enter into the bone marrow.
Complications include:
- Anaphylaxis
- Volume overload
- Transient GVHD
Also, stem cell products that have been cryopreserved contain dimethyl sulfoxide (DMSO), a preservative, and can potentially cause renal failure in addition to the unpleasant smell and taste.
Cryopreserved umbilical cord blood is thawed either in the lab or at the bedside and administered by syringe over 10-15 minutes by the physician.
