Transplant
Heart Health
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Dr Lee Yuh Shan
Haematologist
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A stem cell transplant is a medical procedure used to replace damaged or diseased bone marrow with healthy stem cells.
It is a critical treatment for patients with certain blood cancers or marrow failure syndromes, where the body's ability to produce healthy blood cells is compromised.
This treatment has revolutionised recovery prospects for patients with certain life-threatening conditions by offering a chance to rebuild their blood and immune systems.
The stem cells are taken from either the:
- Blood stream
- Bone marrow (i.e. bone marrow transplant)
- Placenta / cord blood
Stem cell transplants in which cell stems are harvested from the blood stream are generally more common than bone marrow or cord blood transplants.
This process, often referred to as haematopoietic stem cell transplantation (HSCT), involves either using the patient's own stem cells (autologous transplant) or obtaining stem cells from a donor (allogeneic transplant).
Learn more about stem cell transplants and how you can begin your transplant journey with us at Mount Elizabeth Hospitals.
Why do you need a stem cell transplant?
A stem cell transplant may be necessary for patients facing various types of blood cancers or bone marrow failure syndromes. Stem cell transplants offer a potential cure or long-term remission for these conditions by replacing diseased or malfunctioning cells with healthy ones.
Conditions treated include, but are not limited to:
The goal is to eradicate cancer cells and introduce healthy stem cells to reconstitute the blood and immune system.
Through the transplantation of healthy stem cells, the hope is to restore normal blood cell production, strengthen the immune system, and ultimately improve the patient's overall health and quality of life.
What are the types of stem cell transplants?
There are 2 primary types of haematopoietic stem cell transplants, each with distinct characteristics and uses:
Autologous haematopoietic stem cell transplants
An autologous transplant is a stem cell transplant that uses your own stem cells, which means you are your own donor. It involves the patient's own stem cells being collected, preserved, and then reinfused after intensive treatment. It is primarily used to treat lymphomas, multiple myeloma, and some solid tumours.Allogeneic haematopoietic stem cell transplants
An allogeneic stem cell transplant uses cells from another donor. The donor can either be a family member or a registered volunteer donor. The donor stem cells must have a genetic typing that matches yours. This procedure requires a donor whose stem cells are a close genetic match to the patient. It is often employed to treat conditions like leukaemia, severe aplastic anaemia, and lymphoma.
Types of allogeneic haematopoietic stem cell transplants:
Haploidentical transplant
A haploidentical transplant is a type of allogeneic transplant where the donor is a half-match to the patient, typically a parent or child. This is an option when a perfect-match donor is not available.
According to the Bone Marrow Donor Programme in Singapore, around 70% of patients requiring stem cell transplants lack a fully matched donor within their family. Hence, haploidentical transplants become a viable option. Compared to fully matched allogeneic transplants, haploidentical transplants offer broader donor availability, potentially shorter waiting times, and improved access to transplantation for patients in need.
There are unique challenges to haploidentical transplants as they are associated with higher risks of graft-versus-host disease (GVHD), where the donor's immune cells attack the recipient's body, as well as infectious complications. However, recent advancements in immunosuppressive therapies and the transplant techniques have significantly reduced these risks.
Syngeneic transplant
A syngeneic transplant is a specialised type of allogeneic transplant where the donor and recipient are genetically identical. This typically means that the donor is an identical twin of the recipient.
In Singapore, due to the rarity of identical twins, syngeneic transplants are comparatively infrequent in the country. Compared to other types of allogeneic transplants, it has a reduced risk of rejection since the donor and recipient share identical genetic makeup, thereby eliminating the need for immunosuppressive drugs. This presents a unique advantage in terms of post-transplant care and long-term outcomes.
What is human leukocyte antigen (HLA) matching?
The key to a successful allogenic haematopoietic stem cell transplant is finding a donor whose stem cells are genetically compatible with the patient. This compatibility is determined through human leukocyte antigen (HLA) matching. HLA matching ensures that the patient and donor share the same HLA type, which is crucial for minimising complications and increasing the transplant's success.
There are several types of donor matches available for allogeneic haematopoietic stem cell transplants. These include, but are not limited to:
- 100% HLA match from a related donor (match-related donor)
- 100% HLA match from an unrelated donor (match-unrelated donor)
- 50% HLA match from a related donor (haploidentical donor)
Stem cell transplant care at Mount Elizabeth
At Mount Elizabeth Hospitals, you will be in the good hands of our skilled haematologists experienced in stem cell transplants and the management of a broad spectrum of blood disorders.
We offer transplant services including:
- Autologous haematopoietic transplants
- Allogeneic haematopoietic transplants
The treatment process generally involves:
Donor evaluation. Potential donors will undergo a buccal swab where their HLA test will be matched against patient. Match-related donors are then required to undergo a general health evaluation.
Harvesting. Stemcells will be collected from the donor either from:
- Peripheral blood - Donor will undergo daily injection of a growth factor for 5 - 7 days. Then, the stem cells are collected from the donor's blood, using the process of apheresis.
- Bone marrow - This procedure is done under sedation in an operating theatre.
Conditioning. The patient will receive chemotherapy and/or radiation to kill diseased cells, suppress the immune system and prepare the patient for infusion of stem cells.
Infusion. Health stem cells will be infused into the patient's body to replace damaged cells. This is a non-surgical procedure similar to blood transfusion.
Engraftment. This is a step in a successful stem cell transplant. The transplanted stem cells begin to grow and produce healthy red blood cells, white blood cells and platelets over the course of 2 - 4 weeks.
Each patient will receive a personalised treatment plan from our transplant specialists. During the procedure, the patient will be assigned a personal transplant coordinator and be directly supervised by one of our experienced transplant consultants.
Our team of specialists work closely with both local and international bone marrow registries to provide patients a higher chance to find a matched donor.
Our haematologists also adopt a collaborative approach, working closely and rigorously with clinicians and caregivers from multiple specialties at hospitals from our expansive IHH Healthcare network to provide the best possible care.
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FAQs on stem cell transplants
Here are answers to commonly asked questions about stem cell and bone marrow transplants.
A bone marrow transplant is a type of stem cell transplant, but these terms are often used interchangeably. In both procedures, healthy stem cells are transplanted to replace damaged or diseased bone marrow. This treatment is commonly used for certain blood cancers and immune disorders.
Genetic diversity inherent in a population like Singapore makes finding a matching donor more complex. Human leukocyte antigen (HLA) markers, which are used to determine stem cell compatibility, are highly variable and closely linked to ethnic background. The more diverse a population, the more challenging it can be to find a match, especially for patients from minority ethnic groups.
The donor pool in Singapore may also be limited compared to larger countries. This is compounded by the lower awareness or willingness to register as a stem cell donor in some communities.
Singapore has initiatives like the Bone Marrow Donor Programme (BMDP), which works to expand the donor registry and increase the likelihood of finding matches for patients.
Moreover, international collaboration with global stem cell registries also plays a vital role in increasing the chances of finding suitable donors.
In Singapore, the Bone Marrow Donor Programme (BMDP) is the primary organisation managing bone marrow and stem cell donations. You can start by visiting their website or contacting them directly to express your interest in becoming a donor.
A haploidentical, or half-matched donor, is usually your parent or your child. Parents are always a half-match for their children. Siblings (brothers or sisters) have a 50% (1 out of 2) chance of being a half-match for each other. It’s very unlikely that other family members (like cousins, aunts or uncles) would be a half-match.
For detailed procedural or cost-related enquiries on stem cell transplants at Mount Elizabeth Hospitals, please contact our hotline at + 65 6812 3396.
The success of a stem cell transplant can vary based on several factors, including the type of transplant, the disease being treated, and the individual patient's response. Generally, here are the key things to consider:
- Initial engraftment: This is the first sign that the transplant is starting to work. It occurs when the transplanted stem cells start to grow and make new blood cells. This typically happens within 10 - 28 days after the transplant. A sign of engraftment is a rising white blood cell count.
- Short-term recovery: The first 100 days after the transplant is critical. During this period, patients are closely monitored for complications such as infections or graft-versus-host disease (GVHD) in allogeneic transplants. This is also when doctors will start to get a sense of whether the transplant is helping to treat the underlying disease.
- Long-term recovery: It can take up to a year or more for the immune system to fully recover. During this time, patients may still be at risk for infections and other complications.
- Disease remission and relapse monitoring: For patients with cancer, regular monitoring will be needed to check for signs of remission or relapse. This can involve blood tests, imaging scans, and sometimes bone marrow biopsies.
- Overall health improvement: The general health and well-being of the patient will also be a measure of success. This includes recovery from the side effects of the transplant, return to normal activities, and improvement in the symptoms of the underlying disease.
It's important to note that each patient's experience with a stem cell transplant can be different, and success rates can vary based on several factors. Regular follow-up with healthcare providers is essential for monitoring progress and addressing any issues that arise.
The duration of the stem cell transplant process varies, depending on the type of transplant and the patient's condition.
The patient will also undergo evaluation, and be assessed on their health condition, severity of the disease, and availability of suitable donor before the preparation stage. In general, here's an overview of how long the key stages may take:
- Preparation (conditioning regimen): This phase involves chemotherapy and sometimes radiation therapy to prepare the body for the transplant. This typically lasts about a week.
- Transplant day: The actual transplant procedure, where stem cells are infused into the patient's bloodstream, is relatively quick, often taking only a few hours.
- Engraftment: This is when the transplanted stem cells start to grow and produce new blood cells. It usually occurs within 10 - 28 days after the transplant.
- Initial recovery: The first 100 days after transplant is crucial for recovery and monitoring. Patients are closely watched for complications and signs of the transplant's success.
- Long-term recovery: Complete recovery and a return to normal activities can take several months to a year or more, as the immune system gradually rebuilds.
Life expectancy after a stem cell transplant can vary widely depending on numerous factors:
- Type of transplant: Autologous transplants (using the patient's own stem cells) generally have a lower risk of complications compared to allogeneic transplants (using donor cells).
- Underlying disease: The type and stage of the disease being treated play a significant role. For some conditions, a stem cell transplant can be potentially curative.
- Age and overall health: Younger patients and those in better health tend to have better outcomes.
- Complications: Risks such as infections, graft-versus-host disease (GVHD), and relapse of the original disease can impact survival.
It's essential to discuss individual prognosis with healthcare providers, as they can provide the most accurate information based on the patient's specific circumstances.
A stem cell transplant is not considered a major surgery in the traditional sense, as it doesn't involve invasive surgical procedures. The process is more like a blood transfusion, where stem cells are infused into the patient's bloodstream through an IV line.
However, it is a significant medical procedure with considerable risks and a long recovery period. The preparation phase, which often involves high doses of chemotherapy and sometimes radiation, is intensive and can have profound effects on the body. The transplant process requires careful planning and close monitoring for complications, making it a major treatment in the field of oncology and haematology.
This page has been reviewed by our medical content reviewers.
