Allogeneic Stem Cell / Bone MarrowTransplants

For patients undergoing allogeneic transplantation, hematopoietic stem cells / bone marrow are collected from a donor who is another person. A donor who is a relative undergoes a pretransplant evaluation and hematopoietic stem cell collection at St. Jude. When a relative is unable to donate stem cells, hematopoietic stem cell procurement is coordinated through the National Marrow Donor Program (NMDP) or other donor registry.

The transplant coordinator is the primary contact with the donor registry and is responsible for arranging the timing and type of cell product collected. All donors undergo an evaluation by an independent physician who is not a member of the Transplant Service. This independent examination assures that the donors are objectively evaluated before the cells are collected. In addition, donors undergo routine screening for infectious disease before cell collection; this screening is standard for all persons who donate blood products. If any abnormality is identified by the pre-transplant screening, the results will be discussed with and provided to the donor for review. Appropriate referral for further evaluation will be made for donors with abnormalities.

Stem cells can be collected from bone marrow or from peripheral blood. Bone Marrow donors generally undergo their pre-evaluation during the week before the bone marrow harvest. They are also seen in the Transplant Clinic on the day before the scheduled bone marrow harvest. At that time, a transplant physician reviews the donors’ blood work and the donor is asked to sign a consent document for the harvest procedure.

On the morning of the procedure, the donor is taken to the pre-operative area where he or she is evaluated by anesthesiologist. If no problems are found during the evaluation, then the bone marrow is harvested while the donor is under general anesthesia in the operating room.  In general, the bone marrow harvest lasts approximately one hour and is done on an outpatient basis. A donor may require oral pain medication for three to four days after the harvest. The donor returns to Transplant Clinic the day after the harvest to have the dressing removed, and, in some cases, to have blood drawn for additional tests. Adult donors (older than 25 years) may go to an adult institution for harvest.

Donors from whom peripheral blood stems are to be collected will undergo a pre-transplant evaluation approximately one week before the donors start taking growth factor medication (G-CSF). G-CSF is administered as a shot under the skin by staff members in the Medicine Room. The growth factor is given once each day for six consecutive days. On the fifth and sixth days of G-CSF administration, patients or donors will undergo apheresis in the Donor Room. During the apheresis procedure, which lasts approximately four to six hours, patients will have a venous access line placed for collection of peripheral blood stem cells.

In some circumstances, blood from an umbilical cord, i.e., “cord blood,” is used as a source of stem cells. Cord blood can be obtained from appropriate cord blood banks.