Your team will monitor your chimerism levels. This measures how well your donor's cells have engrafted, i.e. how many of your blood cells are being produced by your donor's stem cells. A large drop in your chimerism level could be a sign of graft failure and you may need to have a
Graft failure
This is also called “failure to engraft” or “non-engraftment.” This is serious but uncommon. The most common treatment for graft failure is another transplant. A second transplant may use cells from the same donor or from a different donor.
Graft failure
It can also happen in patients who get a low number of stem cells, such as a single umbilical cord unit. Still, it's not very common. Graft failure can lead to serious bleeding and/or infection.
When the new stem cells multiply, they make more blood cells. Then your blood counts will go back up. This is one way to know if a transplant was a success. Your cancer is controlled.
Relapse of the original malignancy after SCT now remains the most frequent cause of treatment failure and mortality. Approximately 40–45% of recipients of HLA-identical siblings and approximately 35% of recipients of unrelated donor transplants will relapse with their original malignancy (Figure 1) [1].
For many patients, there are treatment options if relapse occurs: A donor lymphocyte infusion (DLI), also called a donor leukocyte infusion, can put some patients back into remission. For others, another transplant may be an option.
Relapse generally results from residual malignant cells that survive the preparative regimen and are not eliminated by the graft-vs-leukemia effect. In a minority of patients, relapse appears to occur in donor-derived cells.
You will feel very tired and run down after your transplant. This will be at its worst during the second and third weeks when your blood cell counts are at their lowest.
Fatigue is an expected side effect of a stem cell transplant. Up to 80% of patients will experience it in the first few months of recovery, and some for much longer.
It can take 6 to 12 months, or even longer, for blood counts to get close to normal and your immune system to work well. During this time, your team will still be closely watching you. Some problems might show up as much as a year or more after the stem cells were infused.
Every year, a small number of patients with a blood cancer or blood disorder who have already received one stem cell transplant from a donor will unfortunately relapse (their disease will come back). For some of these patients, their doctor might recommend a second donor stem cell transplant.
Day 100 is a milestone that many stem cell transplant recipients circle boldly on their calendars as the turning point in their recovery. That's when the greatest risk for critical side effects is past and when the stem cells have engrafted and begun making new blood cells.
(09:35) The most common cancers that develop after a transplant using donor cells (allogeneic transplant) are lung, breast, colorectal, and prostate cancers and melanoma.
Stem Cell Transplant Success Rate
However, recent research provides some encouraging numbers. For instance, when it comes to treating multiple myeloma with autologous stem cell transplants, recent studies suggest a three-year survival rate of approximately 79%.
The body's immune system can attack the donor stem cells. This is called rejection. The transplanted cells can attack the body's cells. This is called graft-versus-host disease.
Persistent anemia is common after allogeneic stem cell transplantation (allo-SCT), with some patients requiring red blood cell transfusions for as long as 1 year [1]. This is of medical concern because repeated transfusions are associated with iron overload and an increased risk of infections 2, 3, 4, 5.
Engraftment syndrome (ES) is a non-infectious complication seen both in autologous and allogeneic hematopoietic stem cell transplants and is characterized by the presence of non-infectious fever, diarrhea, skin rash, pulmonary infiltration, pulmonary edema, and deranged renal and liver function tests.
Foods to avoid (unsafe):
Cold meat or poultry. Raw eggs. Eggs not well-cooked such as sunny-side-up (runny yolk) Cold soups and gazpacho, all miso products such as paste and soup.
Engraftment usually happens within the first 30 days after your transplant but sometimes can take longer. Engraftment means your new cells are working properly and starting to rebuild your immune system. Engraftment marks the start of your recovery process.
You may feel well enough to start going back to your usual level of activity. From this point on, you'll probably feel better and better. For most people, however, the first 2 to 3 months to 1 year after transplant remain a time of recovery.
Respiratory infections
Developing a respiratory or chest infection is very common after stem cell transplant, especially in winter. The cause and treatment can vary so it's important that you tell someone if you have any symptoms such as a dry, wet, or painful cough or shortness of breath.
Physical activity and exercise
You will find that your fitness, endurance and muscle strength will have reduced during your treatment. Keeping active and slowly building up towards structured exercise will be an important part of your recovery. Find something that you enjoy, such as walking, swimming or yoga.
Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant. What's your advice for patients considering an autologous stem cell transplant?