Haematology includes bone marrow transplant, stem cell transplant, pheresis or chemotherapy and is used to treat cancers that are treated with non-surgical therapy such as leukaemia, lymphomas, Hodgkin's, non-Hodgkin's, multiple myelomas, and immunological disorders

For more information on Alberts Cellular Transplant (ACT), the Haematology Division of ABJ, please click here.

High Dose Chemotherapy and Stem Cell Rescue

The practice of stem cell transplantation can be autologous (where the patient is their own donor) or allogeneic (where someone else is the donor – either a sibling or a registry, unrelated donor). Stem cell transplants are mostly performed for malignant blood conditions (e.g. Leukemia, Myeloma, Lymphoma etc) or for bone marrow failure syndromes. The transplant of marrow stem cells allows higher (myeloablative) doses of chemotherapy to be given and in some transplants (from an allogeneic donor) allows a "clean" marrow and new immune system to replace the diseased marrow.

The practice of transplantation is technically complex and requires state of the art equipment, highly trained staff, attention to detail and quality control. The process involves much interaction between the transplant team and the patient and their family. In addition a lot of time is spent coordinating the transplant between the patient their donor, the registry, the harvesting, cryo-preservation (freezing), chemotherapy or radiation department and working with the medical aid.

The Alberts Cellular Therapy transplant unit has a ward dedicated to transplantation and haematological disease management, as well as our own harvesting equipment and staff, our own laboratory to assess the quality of the harvest, our own state of the art cryopreservation and storage facility and management team to co-ordinate the process. We are in the process of exploring options to manage our own Tissue Typing, immunology assessments and Infectious Disease testing.

Our vision is to provide a state-of-the-art, comprehensive stem cell transplant service which will be able to do mismatched, haplo-identical and cord blood transplants in a comparable environment to the best units in the world. To this end we have designed and are currently building a new unit with high efficiency positive pressure air conditioning and other modern infection control measures in place.

For more information on Alberts Cellular Transplant (ACT), the Haematology Division of ABJ, please click here.

Frequently Asked Questions

Why is a stem cell transplant needed?

In patients with leukaemia, aplastic anaemia, and some immune deficiency diseases, the blood stem cells (responsible for creating different types of blood cells) in the bone marrow malfunction, producing an excessive number of defective or immature blood cells (in the case of leukaemia) or low blood counts (in the case of aplastic anaemia). The immature or defective blood cells interfere with the production of normal blood cells, they accumulate in the bloodstream, and they may invade other tissues.

Large doses of chemotherapy and, in some instances, radiation is required to destroy the abnormal stem cells and abnormal blood cells. These therapies, however, do not kill only the abnormal cells; they also destroy normal cells found in the bone marrow. Aggressive chemotherapy used to treat some lymphomas and blood cancers can destroy the healthy bone marrow. A stem cell transplant enables physicians to treat a disease such as leukaemia with aggressive chemotherapy by ensuring that the diseased or damaged cells are replaced with the healthy stem cells of a suitable donor.

Does a stem cell transplant involve an operation?

When people hear the word “transplant”, they think of a surgical procedure in theatre. In reality, stem cells are given to patients intravenously in a period of 30 minutes to one hour, depending on the volume of the cells given, almost like a blood transfusion. The stem cells travel to the bone marrow where they set up home to begin to rebuild the body’s blood and immune systems. The stem cell infusion or stem cell transplant takes place in the patient’s room in the stem cell transplant isolation ward.

Which conditions can be treated with a stem cell transplant?
  • Acute and chronic leukaemia
  • Myelodysplastic syndrome
  • Primary myelofibrosis
  • Multiple myeloma
  • Lymphoma
  • Aplastic anaemia
  • Some immune system disorders
Types of transplants

In a stem cell transplant, the patient’s diseased stem cells are destroyed by chemotherapy and, in some instances, radiation. Healthy stem cells are infused into the patient's blood stream. The new cells migrate to the cavities of the large bones where they start to function (engraftment) and produce normal blood cells.

Autologous stem cell transplants

In autologous stem cell transplants, patients donate their own blood stem cells for infusion. Patients’ blood stem cells are collected in advance, while they are in remission, and then returned to them after they have received high doses of chemotherapy and, in some instances, radiation.

Most people have a single autologous stem cell transplant. Others have a tandem transplant where two autologous transplants are given over a period of a few months. This approach is used to help reduce the chances of disease coming back (relapsing) in future.

Allogeneic stem cell transplants

In allogeneic stem cell transplants, the stem cells are donated by another person whose tissue type is compatible with the patient's. The first choice as a donor is a brother or sister (who has the same mother and father) with a compatible tissue type. If the patient doesn’t have a compatible sibling, a matched unrelated donor will be chosen from the bone marrow registries in South Africa or from bone marrow registries overseas. Another type of donor is a haploidentical related donor – a donor who is a 50% match to the patient. This type of donor can be a parent, sibling, or child. Allogeneic transplants often offer the best chance of curing a number of blood and bone marrow cancers.

What does the stem cell transplant process involve?

When people are diagnosed with acute leukaemia, for example, they will get induction chemotherapy first to achieve remission. While patients are receiving their induction therapy, the transplant administration team will start the search for a compatible donor. Once patients are in remission and they have a compatible donor, their transplant will be scheduled. Before donating their stem cells, donors undergo rigorous medical tests to ensure that they are healthy enough to donate their stem cells.

Prior to hospital admission for their stem cell transplant, patients will undergo medical tests to ensure that they are fit enough to undergo a transplant. Furthermore, the transplant physician and social worker will prepare patients for the transplant by giving them the opportunity to discuss any concerns they may have, and to give them detailed information about the transplant and post-transplant care.

Once patients are admitted to hospital for their stem cell transplant, they will start conditioning therapy to prepare their bodies for the new stem cells. Conditioning therapy consists of intensive chemotherapy and, in some instances, radiation therapy. One day after patients have completed their conditioning therapy, they will receive their donor cells. The day of the stem cell transplant is called Day Zero.

On the day of the transplant, patients will receive premedication containing antihistamine which will help prevent an allergic reaction during the infusion of the donor stem cells. The patient’s vital signs will be checked before, during and after the transplant. The donor stem cells will flow into the patient’s body through a central line, in the same way as a blood transfusion. The infusion of the stem cells into the patient’s body usually lasts 30 minutes to one hour, depending on the volume of the cells given.

Stem cell transplant patients will stay in a high-care isolation ward for two to four weeks after Day Zero. A transplant physician will visit patients every day to monitor their progress. Some side effects of the treatment that patients might experience include fatigue; diarrhoea; nausea and vomiting; ulcers inside the mouth or throat; weight loss and lack of appetite; as well as a high risk of contracting infections. Transplant patients will receive antibiotics to help prevent and fight infections. Blood and platelet transfusions will be given when necessary.

Engraftment takes place when the patient’s new stem cells start to function and produce normal blood cells. Once the transplant physician is satisfied that the patient’s side effects to the treatment are under control, and that infections are resolved, the patient will be discharged.

What happens after the transplant?

Once transplant patients are discharged from hospital, they will have weekly follow-up consultations with the clinical haematologist. These consultations will continue until at least 100 days after Day Zero. Thereafter, patients will see their doctor less frequently. At the appointments, blood tests will be done, and allogeneic transplant patients will receive an intravenous infusion in the chemotherapy room at the practice. This infusion contains a high level of human antibodies to help fight infections and strengthen the body’s natural defence system.

After their discharge from hospital, allogeneic stem cell transplant patients will need to isolate at home until 100 days after Day Zero, as they are immunosuppressed and at a high risk of contracting infections. Although their stem cells have engrafted, their immune system will take longer to recover to an optimal level of functioning.