Treatment Stem cell transplant for aplastic anaemia What is a stem cell transplant? Aplastic anaemia is a rare disease in which the bone marrow’s stem cells are damaged and do not make enough blood cells, including red and white blood cells, and platelets. Therefore, for some patients, a stem cell transplant may be the best long-term solution. A stem cell transplant is also the only form of treatment which, when successful, can cure aplastic anaemia. A stem cell transplant involves infusing healthy stem cells from a donor into your bloodstream. These stem cells travel to your bone marrow, where they begin producing new red blood cells, white blood cells, and platelets. Whether a stem cell transplant is the right treatment for you depends on several factors, including your response to previous treatments, your age, existing health conditions, the availability of a well-matched donor, and, most importantly, your informed consent. After you and your medical team have discussed and agreed that this is the correct option for you, your stem cell transplant can go ahead. The exact timing of the start of your transplant can depend on a variety of factors, such as when your donor is available to donate their stem cells. This can take some time, and your medical team will discuss this with you. Finding a donor For a stem cell transplant to happen, it is important to find a donor whose tissue type closely matches yours. The donor must undergo comprehensive testing and screening to ensure their suitability for the procedure after they have given consent. Your medical team will do a blood test, taking a small sample of blood to establish your tissue type. This information will be used to find a matching donor for you. Your siblings can be tested, as they have a chance (one in four) of being a perfect match for you. However, only one in three people in need of a stem cell transplant have a matching donor within their family, so it is likely that your donor will be somebody unrelated to you. This is called a matched unrelated donor (MUD). Your hospital will forward your tissue type information to organisations like Anthony Nolan or DKMS, which manage stem cell registries in the UK. They will use this information to search for potential matching donors in their database and can also look for donors globally. Please be aware that this process may take some time. For some individuals, especially those from certain minority ethnic backgrounds, finding a matching donor can be more challenging due to possibility of having a rarer tissue type. Your medical team will be available to answer any questions or discuss any concerns that you may have about the process. Before your stem cell transplant You will meet with your transplant team, who will discuss the process with you in detail, and you will sign a consent form. You will also have various tests before your transplant, such as your liver and kidney function and tests to confirm how your heart is functioning, to make sure that you are well enough to go ahead with the transplant. It is recommended that you take time to prepare for both the transplant procedure and its potential long-term effects on your daily life. Most people require several months to rest and recover before returning to work. Additionally, full parenting or caregiving responsibilities may not be possible for some time, so careful planning in advance is essential. Maintaining a healthy lifestyle while preparing for your transplant can greatly support your recovery. Focus on eating a balanced, nutritious diet and staying active when possible. Exercise doesn’t need to be intense—something as simple as a gentle walk can benefit both your physical and mental well-being. Conditioning therapy To prepare your body for the new stem cells, you will need to have a treatment called conditioning therapy, which will last about a week. Conditioning therapy involves a combination of chemotherapy drugs which will create space in your bone marrow for the new stem cells and help them engraft successfully. These drugs also suppress your immune system to reduce the risk of your body rejecting the new stem cells. There are several conditioning regimens and chemotherapy drugs available. Your transplant team will discuss the most suitable option for you, including potential side effects, in detail. To simplify the process of administering medication, you will have a central line fitted shortly before conditioning therapy begins. This is a thin plastic tube inserted into a large vein, either in your neck or upper chest (called a Hickman line) or in your upper arm or near the elbow (called a PICC line). The central line allows your medical team to administer medications, take blood samples, and deliver the stem cells directly. Some people find the process of having a central line fitted uncomfortable. However, your medical team will use plenty of local anaesthetic to ensure you’re as comfortable as possible. You may experience some soreness or bruising in the days following the procedure, but this should ease within a few days. On the day of your transplant The stem cell transplant typically takes place the day after your conditioning therapy is completed. Day 0. First, your pulse, blood pressure, and temperature will be checked. You’ll be given medication to reduce the risk of a reaction during the transplant. The stem cells will then be infused through your central line, similar to a blood transfusion. This process usually takes less than an hour but may take longer depending on the volume of stem cells. The transplant itself is not painful, and you will remain awake throughout. It feels much like receiving a standard blood transfusion. Once the infusion is complete, your central line will be flushed with saline (a sterile saltwater solution) to keep it clean. Your vital signs—blood pressure, pulse, and temperature—will be checked again. Although the stem cell transplant is complete at this point, you’ll continue to be closely monitored until the new stem cells begin to grow and produce healthy blood cells. After the transplant After the transplant, you will need to stay in the hospital for recovery. This usually lasts about six to eight weeks but can vary depending on your individual progress and response to treatment. In a successful transplant, the new stem cells travel through your bloodstream to your bone marrow, where they attach and begin producing new blood cells. This process, known as engraftment, typically takes about two to three weeks. During this time, your blood will be tested regularly. The first sign of successful engraftment is an increase in some or all of your blood cell or neutrophil counts. Before engraftment happens, you may require blood and platelet transfusions several times a week until your body starts producing these cells on its own. Even after engraftment, additional blood or platelet transfusions may still be necessary, as it takes time for your new blood cells to develop fully. This is a normal part of the recovery process and does not indicate that the transplant is unsuccessful. Once you have neutrophils increasing in your full blood count, your medical team may conduct tests to establish whether your new neutrophils are from your donor, and whether the transplant has been successful. The tests may vary depending on your transplant centre, but your team will be able to tell you what to expect, and you can ask them questions about what each test result means. Your stay in hospital During your stay in hospital, you will need to take a few different medications for the following reasons: To protect your new immune system To protect you from bacterial, viral and fungal infections To control symptoms and side effects On the day of your stem cell transplant (and possibly before), you will be placed in protective isolation. This means you’ll be in a germ-free environment, separate from other patients, to help prevent infections while your blood counts are low. Your medical team will closely monitor your physical condition and blood tests, ensuring that everything stays normal and addressing any potential issues early. Many hospitals suggest you to choose only a few people to visit your room. You can also stay connected through social media or phone calls. Unfortunately, most transplant wards do not permit children under 12 years to visit patients due to infection risk. If there are reasons for something different discuss with your nursing team. Though isolation may feel unusual, sticking to a routine can help you manage. While you may experience fatigue during your hospital stay, even simple activities like showering daily or getting out of bed for meals can help you feel grounded. Entertainment options such as books, music, movies, games, or podcasts can also make the time go by faster. A small task can help to feel you have achieved something during the day, or writing things down. I found getting dressed a big help! Lisa, a stem cell transplant recipient Even a small amount of physical activity can help to reduce fatigue and maintain physical strength. A physiotherapist should be able to give you specific advice about activities that you can undertake safely. Some wards will have an exercise bike as a possible option to gently introduce activity. Side effects of receiving a stem cell transplant for aplastic anaemia In the initial weeks of your recovery, it’s normal to experience some side effects, and some may persist for a longer period. Most of these early effects are a result of the chemotherapy you received during conditioning therapy, and can include nausea or vomiting, diarrhea, a sore mouth, loss of appetite, weight loss, hair loss, fatigue, and an increased risk of infection. These side effects are quite common, and they can typically be managed or treated effectively. It’s crucial to keep your medical team informed if you experience any of these symptoms so they can help you manage them appropriately. Graft versus Host Disease (GvHD) Your stem cell donor will typically be well-matched to you, but not identical, which can lead to an immune response from the donor cells against your own cells. This is known as Graft-versus-Host Disease (GvHD). It can present in several ways, with common symptoms including an itchy skin rash, vomiting, or diarrhoea. It can also affect other parts of your body, such as the eyes, liver, lungs, or genitals. Your transplant team will monitor you closely for any signs of GvHD, as it can usually be treated effectively if caught early. To minimize the chances of GvHD occurring, you'll be given medications like ciclosporin or tacrolimus to prevent it. You’ll likely need to take these for nine months to a year after your transplant. Fatigue Fatigue is a very common side effect. As strange as it may sound, gentle exercise can reduce treatment-related fatigue. Fatigue can feel very overwhelming, but being aware that your energy levels are likely to fluctuate can help to keep things in perspective. I was asleep more than I was awake the first few months – I think understanding that this is a normal level of tiredness is important - someone warned me beforehand and I was SO grateful as I just slept when I needed to. It was an issue for me up to 2 years post-transplant and even now I still feel fatigued. Lisa, a stem cell transplant recipient Fatigue can be managed by: Maintaining your energy levels and planning ahead Physical activity and gentle exercise Sleeping well and regularly Learn more about managing fatigue Returning home When the time comes to return home, you may feel relieved, but also concerned about coping without the constant support that you received in hospital. You can reassure yourself with the thought that your doctors and medical team will only recommend that you return home when they feel that you are ready to do so. Returning home is a big step in your recovery, but it can feel strange and isolating, especially if you spend large parts of the day alone, or if you live alone. Breaking the day down into achievable goals can help the day to pass more smoothly, for example taking a short walk or preparing a favourite meal. Reach out to patient support groups or your transplant CNS team if you have any questions or concerns. Mental health To help with your mental health, there are various techniques that you can try, including deep breathing, meditation techniques and mindfulness. There may be a time when you need extra support to help you cope. We would recommend that you talk to a medical professional if: You’ve been feeling low for more than two weeks You find yourself unable to perform even important tasks because of a lack of motivation You find yourself significantly more anxious than usual The AAT can support you with your emotional wellbeing and have a variety of services we can offer you. Find more about our emotional wellbeing support. Immunosuppressive medications To reduce the risk of GvHD and also to make sure that your transplant is successful, it is likely that you will need to continue taking some immunosuppressive medications for approximately a year after your transplant, however for some they need to take these medications for longer. These help stop your immune system from rejecting your new stem cells. After this time, your medication will be gradually reduced, with the aim to stop. Ongoing issues after Stem Cell Transplant A stem cell transplant can have a significant impact on your life in the long term, but the extent of these effects can vary. For some people, there are no long-term issues, while others may face ongoing challenges. It's important to remember that the main goal of the transplant is to improve your overall health and well-being. In some cases, a stem cell transplant can affect fertility or lead to early menopause, though these issues are less likely, as the chemotherapy given before the transplant is typically not as harsh. However, there may be a slightly increased risk of developing a secondary cancer later in life due to the chemotherapy you receive. Early diagnosis is crucial for treating cancer, so it’s important to consult a doctor if you notice any symptoms. While many side effects may improve quickly, some could develop later or persist for a longer time. These could be linked to changes in medication, how well your new immune system is developing, or complications like GvHD. You will be closely monitored for an extended period to ensure that no long-term effects from the treatment emerge. These include: Weight loss Pain Diabetes Issues with joints and muscles Kidney or liver problems Cataracts Loss of libido Memory loss and concentration issues This list may seem overwhelming, but it is extremely unlikely that you will develop all of these issues. In some cases, you may not experience any. For this reason, you will be followed up for checks after your transplant. Depending on your treatment centre, you may be discharged (usually after a period of years) but they will likely have an open door for referral back if any symptoms arise in the future. Hospital visits Everyone’s recovery after transplant is different, and some people may need to visit the hospital more often and for longer. However, the frequency of these visits will decrease over time, reducing to monthly, with the aim of reducing to annually. It’s important to know that setbacks, such as picking up infections, can happen through no fault of your own during recovery. This may mean that you need to spend some time back in the hospital. While this can be frustrating, it's a very common and expected part of the recovery process after a stem cell transplant. Your medical team will be there to support you and help manage any complications that arise, ensuring the best possible recovery. Your relationships Having a stem cell transplant can be a challenging time for you and for those closest to you. You may find that your roles and responsibilities at home and work change, as well as you needing to rely on others for support more than usual. As much as possible, try to keep talking and communicating with others, and avoid making any life-altering decisions at this time. Having a stem cell transplant can be an intense and difficult experience, but the ultimate aim is that your life moving forward will be vastly improved. If you have any questions or concerns, your clinical team should always be able to advise and assist you. The Aplastic Anaemia Trust Support Line is also available for anything you might want to talk about. Want to hear from other people who have had a stem cell transplant for aplastic anaemia? We hold monthly online chats for people who are pre- or post- transplant. Find upcoming dates on our events page. You can find blog articles and videos from people talking about their experiences of transplant here. Manage Cookie Preferences