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In this type of transplant, stem cells are donated by another person (a donor). Doctors call this an allogeneic transplant or an allograft. It is sometimes used as part of the treatment for cancers that are in the bone marrow, such as leukaemia and myeloma. It can also be used to treat some rare non-cancerous diseases of the bone marrow or the immune system.
Treatment with high-dose chemotherapy is given to destroy the cancer cells in your bone marrow. This also destroys your healthy stem cells. After the treatment, stem cells donated by someone else (a donor) are given to you by drip. The stem cells go into the bone marrow and start to produce blood cells. This helps you to recover from the high-dose treatment.
The most suitable donor is usually a brother or sister whose bone marrow is a close match to your own.
Occasionally it is possible to use stem cells from a person who is not related to you, if tests have shown that their white blood cells are a good match with yours. This is known as a matched unrelated donor (MUD) transplant.
The stem cells from a donor will contain immune cells. These immune cells can sometimes attack some of the cells of the person who has received the transplant (the recipient). This can cause a reaction in the body known as graft-versus-host disease (GvHD). As well as attacking healthy cells, the immune cells from the donor may also attack any cancer cells that are left. This is known as graft-versus-disease (GvD).
An allogeneic transplant is a very serious and complicated procedure. This intensive treatment is carried out in specialised transplant units in larger university hospitals.
Donor stem cell transplants may be used to treat some types of leukaemia, lymphoma and myeloma. These allogeneic stem cell transplants are used to improve the chances of curing the disease or prolonging a remission. A transplant may be carried out in the early stage of treatment when the disease is in remission. A transplant may also be done if the illness comes back after treatment. There are different types of leukaemia and lymphoma and a donor transplant is not a suitable treatment for everyone. Whether there is a suitable donor is one of the important factors for doctors to consider.
Other factors your doctor will take into account when considering whether to recommend a transplant for you are your age and general health. There are no lower age limits, but guidelines recommend that for donor transplants the upper age limit is 45–50. This is because the risk of severe graft-versus-host disease is much higher after that age. However, sometimes a donor transplant may be given to people older than 45–50. This depends on your general health and the risk of recurrence of the disease.
A donor stem cell transplant procedure is extremely demanding, both physically and emotionally. You may need to stay in hospital for 4–6 weeks or longer. For most of that time you will usually be in a room of your own, and you will probably feel very ill.
An allogeneic stem cell transplant is a complicated and specialised treatment. It has many side effects and possible complications.
The main risk comes during the time after the high-dose treatment when your bone marrow is recovering. At that time, you are at risk of possible life-threatening infections and bleeding. There is also the risk of graft-versus-host disease, in which the donor’s marrow or stem cells react against your own tissue. Very occasionally, the donated marrow or stem cells do not start to produce new blood cells (this is called graft failure). If this happens it may be necessary for you to have more stem cells donated by the same donor.
Your age and general state of health are key factors to take into account. A transplant takes a long time and may make you very ill. If you are at the upper age limit and your general health is not good, you are more likely to have complications.
You need to weigh up the benefits and risks of this treatment very carefully. The treatment may give a greater chance of curing the cancer than any other type of treatment. However, this has to be weighed against the possible side effects and the fact that some people die during the procedure. You will want to discuss this in detail with your doctor and your family. Most hospitals that carry out blood stem cell transplants have a transplant counsellor you can talk to about any fears or worries.
One issue that your doctor should discuss with you, if it is relevant for you, is fertility. Unfortunately, infertility is usually a side effect of the intensive treatment, for both men and women. There is a higher risk of infertility with an allogeneic (from a donor) transplant than with high-dose treatment with stem cell support. See the section on life after high-dose treatment for more information.
If I do have a transplant from a donor...
If I don’t have a transplant from a donor...
You do not need to feel that you have to rush into making a decision about whether to have a donor transplant. Most doctors understand that you may want time to think about their recommendations, and to discuss them with your family or other people close to you. Most hospitals have staff you can talk it over with, such as a nurse specialist, a transplant coordinator, a social worker and a counsellor.
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