All patients must have double or triple lumen central lines placed before the start of stem cell transplant. This allows adequate access for drawing blood samples and giving medicines through the vein during the transplantation process. Occasionally blood samples must be drawn from peripheral veins. Specific instances where peripheral blood samples are required include the development of a new fever and coagulation (blood clotting) studies.
Patients are admitted to the Stem Cell Transplantation Unit at St. Jude the day before the conditioning regimen begins. The conditioning regimen, also known as the preparative regimen, helps prepare the recipient’s body to receive the autologous or allogeneic hematopoietic stem cell graft. The graft is the stem cell source. This conditioning regimen may consist of chemotherapy alone or in combination with total body irradiation and typically lasts 5 to 10 days.
After the conditioning regimen, stem cells are given to the patient in the patient’s room. The stem cell infusion is done through the patient’s central line. On this day, the patient typically receives medications designed to prevent allergic reactions to the stem cell product. The patient’s heart rate, respiratory rate, oxygen levels and temperature are monitored for several hours after the stem cell infusion.
During the two to three weeks after the infusion of stem cells, the patient is neutropenic. That means the child has fewer white blood cells to fight infection. Recipients of autologous stem cell transplantation will receive granulocyte colony-stimulating factor (G-CSF). Recipients of allogeneic transplant typically do not.