Allogeneic blood stem cell transplant timeline

Your path to transplant most likely starts with your hematology/oncology doctor (doctor who treats blood cancers and blood diseases) after your diagnosis. Ask your hematology/oncology doctor for a referral to see a blood stem cell transplant doctor.

It's best to meet with a transplant doctor as soon as possible, even if you need to have other treatments first. Transplant timing matters. Patients usually do better when a transplant is done earlier in the course of their disease. If you need an allogeneic transplant, it can take time to find the best related or unrelated donor match so starting the search early is important.

You and your hematology/oncology doctor will choose a transplant center, or a transplant center may be recommended to you. Then a transplant coordinator will set up an appointment with a transplant doctor. The length of time from your referral to your appointment will vary depending on the transplant center, your diagnosis and your overall health.

To find your best donor match, your doctor first needs to know your HLA type. You'll either have blood drawn or the inside of your cheek swabbed. A lab tests your blood or cheek swab to figure out your HLA type.

Your hematology/oncology doctor may take a cheek swab for your initial HLA typing before you see a transplant doctor. Sometimes this doesn't happen until you go to the transplant center for your first appointment.

It can take time to find a donor. Going through the first steps of the donor search early may improve your chances of getting a transplant quickly if needed.

Your transplant doctor will start the search for your best related donor, unrelated donor or umbilical cord blood match. If a family member (brother, sister or parent) is a potential donor, your doctor will ask them to have their HLA typed using a check swab or blood sample. This might happen at the same time they're getting your HLA typed. Your doctor will likely also search the NMDP Registry^SM of potential unrelated donors and cord blood units.

Your doctor chooses the best source for you based on HLA matching, the type and stage of your disease and other factors. If an adult donor is chosen, they'll have more blood tests and a physical exam to make sure the donation is safe for you and the donor. If a cord blood unit is selected, it will be tested and sent to your transplant center.

There are costs when a donor has lab tests. Your insurance company may pay for these costs or you may be eligible for a financial grant from NMDP^SM.

Before transplant, you'll undergo more tests to make sure you're healthy for transplant. Your doctor will review your health history, including previous infections and treatments. The physical exam and testing will help your doctor better understand your body and develop a plan for preventing complications.

When you're admitted to the hospital, you'll be in a special section for transplant patients. You'll meet your transplant team and learn about hospital policies, like the rules for visitors. You'll get a central line placed if you don't already have one. A central line makes it easier and more comfortable for you to get your medications. You'll also receive your blood stem cells through your central line.

Getting your body ready for a blood stem cell transplant is called a preparative or conditioning regimen. This includes chemotherapy and possibly radiation therapy. Chemotherapy and radiation destroy the diseased cells in your bloodstream as well as the blood-forming cells in your bone marrow to make room for your new cells. They also weaken your immune system so it can't attack your donated cells after transplant.

Often called "day zero," transplant day is usually 1 or 2 days after the preparative regimen. The donated cells arrive in blood bags, just like the ones used in blood transfusions. Your new cells are given to you (infused) through your central line. This can take 1 to several hours. Larger volumes of cells take longer to infuse. The number of cells you need is based on body size. The donated cells will move through your bloodstream to settle in your bone marrow.

Days 0-30 are when the donated cells start to grow and make new blood cells. This is called engraftment. Engraftment is an important milestone in the blood stem cell transplant recovery process. During days 30-100, doctors will watch you carefully for infection and complications, such as graft-versus-host disease (GVHD). After the donated cells begin to grow and create new blood cells, your blood cell counts will begin to go up and your immune system will become stronger. Throughout your recovery, you’ll need a caregiver to provide support and care. Most transplant centers require patients to have a caregiver.

Sometime during the first 100 days after transplant, you may be able to leave the hospital and receive outpatient care. In the first weeks or months after leaving the hospital, you will go to the outpatient clinic often, sometimes daily, for care. This is a time for you to focus on getting enough rest and rebuilding strength. It will take time for your body to heal.

After donation you may be interested in finding out more about the person who donated your new blood stem cells if your donor was not a family member. Rules vary from country to country and it’s possible that your donor may live in another country. During the first year after transplant, transplant centers from most countries allow anonymous communication. After one year, you may be allowed direct contact if the donor agrees. Some areas have a 2 year or more waiting period; some don’t ever allow contact between donors and recipients.