What to Expect from Stem Cell Transplant and Cellular Therapy

It’s normal to have concerns or feel nervous about getting a stem cell transplant or cellular immunotherapy. Your care team at Henry Ford takes the time to explain your treatment and answer your questions. Here’s what you can expect along the way.

Meeting your Henry Ford care team

At your first appointment, our team helps you understand your condition and procedure. We’ll confirm your diagnosis, explain your treatment options and answer any questions you have.

Your care team:

• Includes multiple experts: You receive care from several specialists who work closely together, including hematologists, oncologists and pathologists. We discuss cases in our tumor board to recommend the best treatment for your unique needs.
• Streamlines your care: Your transplant coordinator helps you through each phase of treatment to ensure your care is as convenient and comfortable as possible.
• Informs your primary care provider: Your transplant team communicates with your referring doctor so you can manage your health over time. 
• Reflects our community: A diverse medical team can understand the needs of all types of patients. We focus on providing the right diagnosis and treatment for every person to improve outcomes for patients from all backgrounds.

Screening for stem cell transplants

You’ll complete several medical tests before getting a stem cell transplant, such as:

• Physical exam, including past medical history
• Blood tests for HIV, hepatitis and other illnesses
• Blood tests for human leukocyte antigen (HLA) tissue type (for transplants received from a donor)
• Bone marrow biopsy
• Imaging tests, including computed tomography (CT), positron emission tomography (PET) and chest X-rays
• Heart tests, including echocardiogram and electrocardiogram (EKG)
• Lung function tests

Other stem cell transplant requirements

To ensure that stem cell transplant is the right treatment for you, you’ll need to: 

• Complete a mental health screening: An assessment by a mental health specialist reveals potential issues that could affect your transplant recovery.
• Abstain from substance use: You must not consume alcohol or use tobacco or prohibited substances for at least six months before receiving a stem cell transplant. You should avoid these substances after your transplant as well. Henry Ford provides addiction treatment and tobacco treatment services for those who need it.
• Form a support system: You need a dependable group of caregivers who can assist you during your recovery.

Finding a donor

Unless we can use your blood-forming stem cells, you need a donor for a transplant. The donor may be a relative or stranger. Sometimes stem cells can come from donated umbilical cord blood. Your transplant team works with you and your family to find a donor match. If there is no matched sibling, then we will search for an unrelated donor using global donor registries.

Human leukocyte antigen (HLA) typing

Your human leukocyte antigen (HLA) type plays a crucial role in finding the right donor match. Our team uses specialized equipment in our advanced Transplant Immunology Lab to determine HLA types.

• HLA typing is important because:
• HLA is a protein, or marker, found on the surface of white blood cells.
• These markers tell your immune system which cells are yours and which ones are foreign and should be attacked.
• Your body is less likely to fight or reject stem cells that come from a donor whose HLA type most closely matches your own.

Waiting for a stem cell transplant from blood or bone marrow

Some patients can use their own stem cells or have a sibling who is a good HLA match. They can receive a transplant as soon as they complete treatments to destroy unhealthy cells.

If you don’t have someone who is a good match, your transplant team will search the donor registry maintained by the National Marrow Donor Program (NMDP). This organization maintains a nationwide list of potential stem cell donors and donated umbilical cord blood.

Factors affecting your stem cell transplant wait

How long you’ll wait for a stem cell transplant depends on several factors, including your:

• Health
• HLA type
• Age
• Race
• Ethnicity

Receiving a stem cell transplant

Once we collect your stem cells or find a donor, a transplant involves three phases:

Stem cell transplant conditioning (pre-transplant)

We take certain steps before your stem cell transplant:

• You check into the hospital and have a long tube called a catheter surgically inserted into a large vein in your chest.
• During the first phase of treatment, called conditioning, you receive high doses of chemotherapy through the catheter. You may also receive radiation. These treatments destroy damaged or cancerous cells and prepare your body to accept transplanted stem cells. Conditioning usually takes a week or two.

Stem cell transplant procedure

A stem cell transplant is a painless and relatively quick procedure. It’s like getting a blood transfusion. You are awake for the procedure and receive the transplant through your central line.

Stem cell transplant recovery

We ask all our stem cell patients to follow Henry Ford’s recovery recommendations:

• After the transplant, you recover in our specialized Transplant Recovery Unit. This unit has private rooms with filtered air to protect against infection.
• You receive daily blood tests while in the hospital. You may need blood transfusions until the donor stem cells start making new blood cells. This process is known as engrafting. You may be given medications to stimulate stem cell production.
• While in the hospital, you meet with one of our knowledgeable transplant pharmacists and start taking transplant medications. If you received donor cells, you take immunosuppressants to keep your body from rejecting the donated stem cells. You may eventually be able to stop taking these antirejection medications.
• During your hospital stay, our dedicated stem cell transplant team will teach you and your caregivers how to care for your central line after you leave the hospital. Proper care is essential to prevent infection.
• After you are discharged from the hospital, you need to make daily or weekly visits to Henry Ford for follow-up tests and monitoring. These visits may continue for the first 100 days after discharge or until your doctor recommends otherwise.
• It may take six to 12 months for your immune functions and blood cell levels to return to normal. It is important to follow your doctor’s orders about medications, checkups and recovery during this time.

What to expect from cellular immunotherapy

Henry Ford provides cellular immunotherapy for certain types of cancers and blood disorders. Cellular immunotherapy modifies your immune system cells to target cancer cells without damaging healthy tissue.

The cellular immunotherapy field is evolving quickly. Doctors may soon identify more conditions that can benefit from this therapy—and new agents to treat these conditions.

Collecting T cells (leukapheresis)

We remove some of your white blood cells, which contain T cells, from your blood using a procedure called leukapheresis.

• You recline in a chair or in bed during the procedure.
• We use a central intravenous line to remove blood and return it to the bloodstream after we remove white blood cells.
• You need to stay still for 2 to 3 hours during the procedure. Leukapheresis can cause numbness, tingling or muscle spasms, which we treat by giving you calcium by mouth or through an IV.
• You return home after the procedure.

Making CAR T cells

After the white blood cells are removed, we freeze them and send them to a manufacturing lab. At the lab:

• The T cells are isolated from the white blood cells.
• The T cells are reprogrammed with a specific chimeric antigen receptor (CAR), turning them into CAR T cells.
• The modified cells grow and multiply. CAR T-cell therapy requires millions of cells, so this growth phase may take a few weeks.
• The CAR T cells are frozen and shipped back to Henry Ford for your treatment.

Receiving the CAR T-cell infusion

After we receive your cells, we infuse them back into your bloodstream.

• Before your infusion, you may receive low-dose chemotherapy. Chemo works to reduce the quantity of your other immune cells, so your new CAR T cells can activate to fight cancer.
• You return to Henry Ford for your infusion appointment. You recline in a chair or bed while the IV line carries the CAR T-cell blood into your bloodstream.
• The altered cells circulate throughout your body, where they bind with cancer cells to destroy them. Then they multiply and target even more cancer cells.

Resources for patients and caregivers

Our attentive Guest Services staff can help you and your loved ones with travel and lodging arrangements, as well as provide other support. Learn more about our resources.