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Transplantation Consultation Center

      • What is hematopoietic stem cell transplantation?

        It is a treatment method wherein the sick hematopoietic process is eliminated and healthy hematopoietic stem cells are transplanted to treat blood diseases.

        Types of hematopoietic stem cell transplantation

        It is divided into autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation. When the patient’s own hematopoietic stem cells are collected and transplanted, it is called autologous hematopoietic stem cell transplantation; if hematopoietic stem cells are collected from the donor, it is called allogeneic hematopoietic stem cell transplantation. The sources of hematopoietic stem cells are bone marrow, peripheral blood, and cord blood; the hematopoietic stem cells of the patient himself/herself, identical twins, sibling-family (related), and unrelated others can be used for transplantation.

        • Autologous hematopoietic stem cell transplantation

          Because only a small amount of autologous hematopoietic stem cells is present in the peripheral blood, it is necessary to mobilize cells from the bone marrow to the peripheral blood using chemotherapy or hematopoietic growth stimulating factor to collect cells sufficient for transplantation. Most patients, after being confirmed not to have cancer cells in the bone marrow, receive chemotherapy such as consolidation therapy; when leukocytes are starting to be restored, their hematopoietic stem cells are collected. They are usually collected for 2-3 days, and then stored frozen until the transplantation day.
        • Sibling allogeneic hematopoietic stem cell transplantation

          When allogeneic hematopoietic stem cell transplantation is decided, the major histocompatibility antigens of the patient and the siblings are tested for matching. If there is a suitable donor among the siblings, the suitability for donation should be checked through physical examination; if the donor is confirmed to be healthy, the transplantation date is determined.
        • Unrelated allogeneic hematopoietic stem cell transplantation

          When there is no suitable donor in the family, donors with matching major histocompatibility antigen should be searched among other people. If there is another donor with matching major histocompatibility antigen, and the intention for donation is confirmed, the donor is finally selected through a complete examination for major histocompatibility antigen, and then hematopoietic stem cell transplantation is performed.
        • Mismatched family haploidentical allogeneic hematopoietic stem cell transplantation

          Mismatched family haploidentical allogeneic hematopoietic stem cell transplantation between parents, children, brothers, and sisters is a type of transplantation technique applied by a specific immunological principle called NK-cell alloimmune response and is often called parent-children and brother-sister haploidentical or partially matched transplantation. When finding unrelated donors takes a lot of time, or urgent transplantation is necessary due to disease progression, family haploidentical allogeneic hematopoietic stem cell transplantation is decided. If it is performed under complete remission condition, the outcome is not that different from that of siblings or other matched transplantation.
        • Cord blood hematopoietic stem cell transplantation

          Cord blood transplantation, using the hematopoietic stem cells in the placenta or the cord thrown out after childbirth, is selected when sibling or unrelated donor transplantation is not possible. Cord blood transplantation has great advantages: transplantation is possible even though the histocompatibility antigen does not match; graft versus host disease develops less often; and it can be used immediately if transplantation is needed. On the other hand, the disadvantage is that its use is limited in children and adults with heavy weight.

        Preparations for hematopoietic stem cell transplantation

        • Pre-transplantation test for the patient

          Transplantation is a process accompanied by large doses of chemotherapy injection or irradiation, various kinds of drugs and fluid administration, and large amount of transfusion. As a result, transplantation-related complications develop for sure, and they can be serious. For successful transplantation, the patient’s physical strength is required to withstand the difficulties of the transplantation process. Thus, pre-transplantation tests are performed to evaluate the disease condition and overall health status of the patient and to confirm whether the patient can physically go through the process of transplantation; cooperative joint examination and comprehensive tests are performed before transplantation. For pre-transplantation joint examination, the Departments of Dentistry, ENT, and Infectious Disease participate; in some cases, joint examination with the Department of Ophthalmology is performed. For test items, pulmonary function test, echocardiography, liver/kidney ultrasonography, infection-related serum, and urine tests are included.
        • Pre-transplantation test for donor

          Prior to transplantation, the physical examination of the donor is performed at the outpatient clinic and at 4 weeks before the transplantation day of the patient to see whether the donor is suitable for transplantation. On the examination day, the donor, after fasting, undergoes blood test, body weight and blood pressure measurement, urine test, ECG, and chest X-ray. If infection is present, or unavoidable treatment is needed, the donor should consult the relevant physician.

        Treatment process after hospitalization at the hematopoietic stem cell transplantation ward

        • Pre-treatment for hematopoietic stem cell transplantation

          The real transplantation process begins when pre-treatment chemotherapy and radiation therapy start so that hematopoietic stem cells prepare the space for engraftment and eliminate tumor cells as well as the patient’s bone marrow for the settlement of new cells. During this period, the patient becomes exhausted and sensitive to stimulation due to chemotherapy and radiation therapy. Therefore, because normal meal eating is difficult, nutrition is provided by TPN.
        • Hematopoietic stem cell transplantation donor hospitalization and hematopoietic stem cell collection and transplantation

          The hematopoietic stem cell donor is hospitalized 1 day before the patient’s transplantation day. The collected hematopoietic stem cells are separated to reduce post-translation adverse reactions and foreign matter, and only hematopoietic stem cells are directly transported to the patient’s room and immediately injected into the patient. In case of autologous transplantation, the collected hematopoietic stem cells are stored frozen until the transplantation day, and then thawed at the side of the patient and immediately injected into the patient on the transplantation day.
        • Engraftment and recovery after hematopoietic stem cell transplantation

          About 1-2 weeks after transplantation, the mucositis in the mouth or gastrointestinal tract is greatly improved along with the recovery of neutrophils, and the constitutional condition becomes better. Bacterial infection can be the biggest problem until the hematopoietic functions are restored; in particular, continuous transfusion is needed to maintain platelets at a certain level to prevent hemorrhage. After the engraftment of the injected hematopoietic stem cells, the peripheral blood findings are gradually restored at around 2 ~ 3 weeks after transplantation; in some cases, however, engraftment is not completed, and additional hematopoietic stem cells are introduced.
        • Discharge after hematopoietic stem cell transplantation

          Discharge from the hospital is considered if the injected hematopoietic stem cells restore the hematopoietic functions with good engraftment and the leukocyte level is increased enough to lead a life outside the clean room. When hospitalization needs to be extended due to the development of complications although leukocytes are restored, the patient is moved to a general ward or an upper-grade ward for treatment, and then discharged. The patient and caretakers receive education on life after hematopoietic stem cell transplantation ahead of time prior to discharge, and the patient’s post-transplantation health condition will be checked through regular outpatient visit after discharge.