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Stem cell transplants are used in the treatment of cancers such as leukaemia, myeloma, lymphoma, and other blood or immune system diseases that affect the bone marrow.
A stem cell transplant, also known as a bone marrow transplant or a hematopoietic stem cell transplant, is a medical procedure that replaces your bone marrow with healthy stem cells. These cells either come from your own body or are taken from a donor.
Stem cells are cells present in the bone marrow that have the unique ability to grow into the blood cells that your body requires to function. Blood stem cells grow into different blood cells, which include red blood cells, white blood cells and platelets:
These make up the bulk of your blood. Your red blood cells carry oxygen throughout your body. If you have insufficient red blood cells, you may be anaemic.
The white blood cells fight pathogens such as viruses and bacteria. They make up a part of your immune system.
Your platelets help to form clots and stop bleeding.
Cancer and cancer treatment, such as chemotherapy, may damage your blood stem cells which will affect the normal production of red blood cells, white blood cells and platelets.
The procedure has been used successfully around the world in the treatment of certain cancers as well as blood and autoimmune disorders, including:
Our team of experts will work with you to determine if you are a suitable candidate for stem cell transplantation. The evaluation process may include the following:
The stem cells used for an autologous transplant are collected from your own body. This is sometimes done because intensive chemotherapy or radiation therapy treatment can damage your stem cells and immune system. Therefore, doctors may remove and store stem cells prior to your cancer treatment.
After chemotherapy, these stem cells are returned to your body to help build and restore your immune system and body’s ability to produce blood cells and fight infection.
Autologous transplants can be done if:
The stem cells used in an allogeneic stem cell transplant are taken from a donor. Allogeneic stem cell transplantation is commonly used for treating aggressive forms of acute leukaemia and myelodysplastic syndromes. It is also used for the treatment of aplastic anaemia, red cell disorders (such as thalassemia) as well as in some cases of lymphoma and myeloma.
Before the actual transplant, chemotherapy is given with or without radiation; it is done to remove any abnormal cells from the bone marrow, so it is ready to receive donor stem cells. This phase is called conditioning and takes 5-8 days.
On the day of the transplant, healthy cells from the donor are infused into the bloodstream through an intravenous (IV) line or tube. This process is similar to receiving medication or blood through an intravenous line. These cells make their way into the bone marrow, where they begin to grow and produce healthy red blood cells, white blood cells and platelets. This phase is called engraftment and takes about 10-14 days.
Allogeneic stem cell transplants require a “donor match”. A donor match comes from a healthy donor whose human leukocyte antigens (HLA) match yours. This process is called HLA typing. The best donor match often comes from siblings with the same parents. However, other family members or an unrelated volunteer may be a match too.
In the event that a suitable donor match cannot be found, there are other options that may be considered, including:
Both blood stem cell and bone marrow transplants produce the same result. A patient will receive stem cells in the same way. The difference between the two comes from how the cells are extracted from the donor.
With most donations, the stem cells are collected from a donor’s bloodstream through a process called peripheral blood stem cell collection (PBSC). Their blood passes through a small tube and into a machine that collects the stem cells. The rest of the blood is then returned to the body. The process is similar to donating blood; however, it takes longer.
While most donations are done through PBSC, others are done through the collection of a donor’s bone marrow in a surgical procedure. A needle is used to extract the bone marrow from the donor’s pelvis while they are under general anaesthesia. A patient receiving cells from a donor extracted by this method would be considered to be having a bone marrow transplant.
The method chosen depends on the condition being treated and factors such as the patient’s health and age. The transplant doctor will advise you as to which method is best suited to your condition.
Our doctors will recommend the transplant option best suited for you based on several factors.
Factors to be considered in your pre-transplant assessment include your disease type, your response to treatment as far, your age and your general health.
The whole transplant procedure is long and involves approximately a one-month in-patient admission, followed by a prolonged recovery phase. While our transplant team will be here to support you as best as possible through your journey, it is always important to identify family members and/or caregivers who can be there to support you along the way too.
Generally, patients above 60 years of age are considered with greater care and assessment before transplantation. However, there is no specific upper age limit for bone marrow transplantation. Your suitability for transplantation will mainly depend on your overall physical status, as well as your underlying disease status.
Our transplant team at CFCH will take all factors into account and have an open and frank discussion about the risks and benefits of bone marrow transplantation on a case-to-case basis.
The cost of a bone marrow transplantation depends on several factors, which include the type of transplant (autologous vs allogeneic), type of donor (related, vs unrelated, vs haploidentical) as well as the disease status of the patient and whether any potential complexities are expected for the procedure.
At CFCH, our team will work to establish the most appropriate treatment strategies for your condition. If a bone marrow transplantation is required, a detailed transparent breakdown of the costs will be provided upfront to you. If you are concerned about the costs required for your bone marrow transplant, feel free to get in touch with us. We will be happy to help you understand the various fees involved.
Once the donor cells have engrafted and you have recovered from your stem cell transplant, you will be discharged home.
After the transplant, you will be monitored very closely with regular visits to the post-transplant clinic.
During the initial recovery period, you are at high risk of infection as your immune system will be suppressed and will take time to regain its normal function. You will need to be monitored closely for infections and will receive antibiotics and antivirals to reduce the risk of infection. Our doctors and nurses will advise you on how to prevent infection, as well as how to watch for signs of infections.
Patients who have had an allogeneic stem cell transplant are also at higher risk of developing a condition called Graft Versus Host Disease (GVHD). This occurs when the donor cells grow too aggressively and attack the cells in the patient’s body. GVHD can be mild, moderate or severe. Your transplant team will be monitoring you for signs of GVHD very carefully and will give you drugs both to prevent and manage GVHD.
During this recovery period, you will have blood tests and bone marrow tests at regular intervals to monitor your condition and to see how well you have responded to the transplant. You may occasionally require blood and platelet transfusions if your blood counts are low.
In order for doctors to determine if your bone marrow transplant is successful, your blood count levels need to return to normal along with your immune system. This can take between 6 to 12 months. Our transplant team will continue to monitor you during this period for any issues that may surface.
Yes, it is possible to live a full and normal life following a stem cell transplant. While it will take time for you to regain your regular level of activity, many patients start to feel stronger between 2 months to a year after their stem cell transplant. However, patients should note that this is still the recovery period, and fatigue is to be expected.
At CFCH, we offer stem cell transplant as a treatment for various blood conditions including Leukaemia (ALL, AML), Lymphoma, Multiple Myeloma, MDS, and Aplastic Anaemia.
Patients with multiple myeloma typically receive an autologous stem cell transplantation as consolidation after they have completed their initial induction phase of chemotherapy.
The response to an autologous stem cell transplantation depends on the disease risk stage of the underlying myeloma, as well as whether a complete remission is attained before transplantation.
Outcomes are improving significantly for patients with myeloma. However, the autologous stem cell transplantation is not curative in most cases and rather serves to extend the duration of remission for treated patients.
ALL patients who do not attain remission after induction or consolidation therapy are usually offered a second-line treatment for an allogeneic haematopoietic stem cell transplantation. In addition, patients with poor prognostic markers on cytogenetics and molecular analysis are also considered for upfront transplantation.
In recent years with the advancement of cellular therapy and targeted immunotherapy, patients are being considered for treatment with these newer therapies before haematopoietic stem cell transplantation.
Not all patients with AML require a stem cell transplantation. However patients with poor risk AML, or those who have not responded well to induction or consolidation chemotherapy will often need to proceed to transplantation if a suitable donor can be identified.
Bone marrow transplant is usually offered to lymphoma patients with high risk subtypes or if they have experienced a relapse after going through other types of cancer treatments like chemotherapy or radiation therapy.
Stem cell transplantation is usually recommended for patients who have high-risk MDS. It is aimed at improving the long-term survival of patients.
At the present moment, an allogeneic haematopoietic stem cell transplantation is the only form of curative therapy for MDS.
Not all patients with aplastic anaemia require a bone marrow transplantation (Allogeneic haematopoietic stem cell transplantation). Patients with more severe forms of aplastic anaemia who have not responded to conventional immunosuppressive therapy or those who have a readily available matched sibling or unrelated donor are often considered for transplantation.
The information on the Centre For Clinical Haematology website is intended for educational use. It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
We partner with major insurance providers in Singapore to streamline the financial process, allowing you to focus on what truly matters: your recovery. Contact our team for more information and support.
The CFCH team is committed to providing patient-centred care and comprehensive multidisciplinary support through every stage of your journey with us.
During your initial consultation, you'll meet our doctors who will listen to your concerns and begin your evaluation and recommend the necessary investigations required.
After diagnosis, we will plan your care, tailoring treatment options to your unique needs for the optimal outcome.
Throughout your treatment journey, we will provide a supportive environment to closely monitor your progress, ensuring your comfort and adjusting care as needed.
After treatment, we will continue to support you with a holistic approach to your recovery, to ensure that both your physical and mental wellbeing are looked after.
