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Stem Cell Transplant: Process, Types, Risks, and Recovery

Hematopoietic Stem Cell Transplant (HSCT) replaces diseased marrow with healthy stem cells—autologous (self) or allogeneic (donor). Curative for many hematologic malignancies and marrow failure syndromes.

Transplant Types

TypeSourceIndicationsKey Feature
AutologousPatient's own (mobilized PBSC)Myeloma, NHL, AML (CR1 favorable), AmyloidosisNo GVHD; lower TRM; no GVT
AllogeneicMatched related/unrelated donor, cord blood, haploidenticalAML, MDS, ALL, CML, severe aplastic anemia, immunodeficiencyGraft-vs-Tumor (GVT) effect; GVHD risk
SyngeneicIdentical twinRareNo GVHD; no GVT

Process Timeline

  1. Workup & Donor Search: HLA typing, organ function, disease status, psychosocial.
  2. Stem Cell Collection: G-CSF mobilization → apheresis (auto/allo donor); marrow harvest (rare); cord unit thaw.
  3. Conditioning (Preparative Regimen):
    • Myeloablative (MAC): Busulfan/Cyclophosphamide, TBI/Cy — eradicates disease, enables engraftment.
    • Reduced-Intensity (RIC): Fludarabine-based — less toxicity; relies on GVT; for older/comorbid.
  4. Infusion (Day 0): Thawed/infused via central line. ABO mismatch managed.
  5. Engraftment (Day +10 to +28): ANC ≥500 × 3 days; platelets ≥20k unsupported. Chimerism monitoring.
  6. Early Recovery (Day +30 to +100): Infection prophylaxis, GVHD prophylaxis/treatment, nutrition, rehab.
  7. Late Recovery (Months 3–12+): Immune reconstitution, vaccination re-immunization, chronic GVHD management, late effects screening.

Major Complications

  • GVHD (Allo only): Acute (skin/liver/GI) & chronic (scleroderma-like, sicca, bronchiolitis obliterans).
  • Infections: Bacterial (neutropenic), viral (CMV, EBV, BK, adenovirus, COVID), fungal (aspergillus), PJP.
  • VOD/SOS: Hepatic sinusoidal injury (MAC, risk factors).
  • Relapse: Primary (no CR) or post-transplant. Donor lymphocyte infusion (DLI), 2nd transplant, targeted therapy.

Outcomes

  • 1-yr OS: Auto 80–90%; Allo 50–70% (varies by disease, risk, donor).
  • Long-term: Cure fractions significant; survivorship care essential (secondary cancers, endocrine, cardiac, psychosocial).

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