An allogeneic stem cell/bone marrow transplant replaces damaged or destroyed bone marrow stem cells with healthy ones from another person. If the donor is a family member, that person is evaluated and donates the cells at St. Jude. When a relative is unable to donate stem cells, the donation is coordinated through the National Marrow Donor Program (NMDP) or other donor registry.
The St. Jude transplant coordinator is the main contact with the donor registry. This person arranges the timing and type of cell products collected. All donors are evaluated by an independent physician who is not a member of the Transplant Service. This exam assures that the donors are objectively evaluated before the cells are collected.
Possible donors also undergo routine screening for infectious diseases before cell collection. This screening is standard for all people who donate blood products. Any issues that may be found are reviewed with the donor. Referrals may be made for further evaluations, if necessary.
Stem cells can be collected from bone marrow or from peripheral (circulating) blood.
A bone marrow donor generally undergoes evaluation the week before the bone marrow harvest. The donor is also seen in the Transplant Clinic the day before the scheduled bone marrow harvest. At that time, a transplant doctor reviews the donor’s blood work and the donor is asked to sign a consent document for the procedure.
On the morning of the procedure, the donor is taken to the pre-operative area to be evaluated by anesthesiologist. If no problems are found, the bone marrow is harvested while the donor is under general anesthesia in the operating room.
In general, the bone marrow harvest lasts about an hour and is done on an outpatient basis. A donor may require oral (by mouth) pain medicines for three to four days after the harvest. The donor returns to Transplant Clinic the day after the harvest to have the dressing removed. In some cases, blood drawn will be drawn for other tests. Adult donors (older than 25 years) may go to an adult institution for harvest.
A blood stem cell donor has a pre-transplant evaluation about a week before beginning to take growth factor medication (G-CSF). G-CSF is given as a shot under the skin by staff in the Medicine Room. The growth factor is given once a day for six days in a row. On the fifth and sixth days, the cells are harvested through a process called apheresis. This method obtains stem cells from a vein in a method similar to a blood donation. The procedure lasts about four to six hours.
Sometimes, blood from an umbilical cord, also known as "cord blood," is used as a source of stem cells. Cord blood can be obtained from appropriate cord blood banks.