Blood Stem Cell Transplant journey

For some people diagnosed with a blood cancer or blood disorder, a blood stem cell transplant offers the best chance of long-term recovery or cure. While every patient's journey is different, understanding each stage of the process can help you feel more prepared and know what to expect.

This guide explains the transplant journey from the moment your doctor recommends a transplant through to your recovery afterwards. Throughout the process, your healthcare team will support you, answer your questions and guide your care.

What is a blood stem cell transplant?

A blood stem cell transplant replaces unhealthy blood-forming stem cells with healthy stem cells from a donor. The goal is to help your body produce healthy blood cells and rebuild your immune system. Blood stem cell transplants are used to treat more than 70 different blood cancers and blood disorders, and over 50,000 transplants are performed worldwide each year.

In South Africa, almost all unrelated stem cell donations are collected using Peripheral Blood Stem Cell (PBSC) donation. During this procedure, the donor's blood passes through a machine that separates the blood stem cells before safely returning the remaining blood back to the donor. The collected stem cells are then prepared for transplantation.

Is a blood stem cell transplant the right treatment for everyone?

Not everyone diagnosed with a blood cancer or blood disorder will need a blood stem cell transplant. Your treatment will depend on several factors, including your diagnosis, how your condition responds to treatment, your overall health and whether a transplant offers the best chance of recovery.

Your haematologist and transplant team will discuss the potential benefits and risks with you before deciding whether transplantation is the most appropriate treatment.

Finding a suitable stem cell donor

Once a transplant has been recommended, the next step is identifying a suitable donor. Around 30% of patients find a matching donor within their own family, usually a brother or sister. The remaining patients rely on unrelated donors found through national and international stem cell donor registries. If a fully matched donor cannot be found, your healthcare team may discuss alternative options, such as a half-matched (haploidentical) donor.

Every donor undergoes comprehensive medical assessments to ensure the donation is safe for both the donor and the patient.

Preparing for your transplant

Preparing for a transplant involves more than medical treatment. Before treatment begins, your healthcare team will carry out several tests to confirm that your body is ready for transplantation. They will explain each stage of the procedure, discuss possible risks and answer any questions you or your family may have.

Many patients also need time to prepare for practical aspects of treatment. This may include arranging leave from work, organising childcare, planning finances or identifying someone who can support you during your hospital stay and recovery.

Every patient's circumstances are different. If transport, accommodation, financial challenges or other practical barriers may affect your treatment, speak to your transplant team or contact DKMS Africa Patient Services. Depending on your individual circumstances, support may be available through programmes such as Access to Transplant (ATT).

Conditioning treatment

Before receiving healthy donor stem cells, you will undergo conditioning treatment. Conditioning usually consists of high-dose chemotherapy and, in some cases, radiotherapy. This treatment prepares your body for the transplant by destroying diseased blood-forming cells, creating space in the bone marrow for healthy donor stem cells and reducing the likelihood of your body rejecting the transplant.

Your treatment plan will be personalised according to your diagnosis and overall health.

The transplant procedure

Although reaching transplant day is a major milestone, the transplant itself is usually a relatively straightforward procedure. Healthy blood stem cells are infused into your bloodstream through a central venous line, much like receiving a blood transfusion. The infusion itself generally takes between 15 and 30 minutes.

Once the stem cells enter your bloodstream, they naturally travel to your bone marrow where they begin producing healthy new blood cells and rebuilding your immune system. Throughout the procedure, your transplant team will monitor you closely and manage any side effects should they occur.

Engraftment: when your new immune system begins to grow

After transplantation, the donated stem cells settle in your bone marrow and begin producing healthy blood cells. This process is called engraftment. For many patients, engraftment begins around 12 to 15 days after transplantation, although recovery differs from person to person.

This is an important milestone because it shows that your transplanted stem cells are beginning to establish a healthy new blood-forming system. During this time, your healthcare team will regularly monitor your blood counts to assess your progress.

Recovering in hospital

Following your transplant, you will remain in hospital while your healthcare team closely monitors your recovery. Because your immune system is temporarily weakened, preventing infection becomes an important part of your care. You may receive medications, blood products or other supportive treatments while your immune system continues rebuilding itself.

Your doctors, nurses and transplant team will also monitor you for possible complications and provide ongoing support throughout your hospital stay.

Going home

Being discharged from hospital is an exciting milestone, but recovery continues well beyond leaving the transplant unit. Before you are discharged, your transplant team will ensure that your stem cells have successfully engrafted, your symptoms are well managed and you have the support you need to continue recovering safely at home.

You will also receive guidance on your medications, follow-up appointments, recognising signs of infection and knowing when to contact your healthcare team.

Recovery after your stem cell transplant

The first few months after transplantation remain an important part of your recovery. You will attend regular follow-up appointments so your healthcare team can monitor your blood counts, adjust medications and identify any concerns early. Some patients may still require blood tests, medications or occasional transfusions while their immune system continues to recover.

Recovery is different for every patient. It is normal to experience both physical and emotional challenges during this time. If you develop symptoms such as fever, difficulty breathing, severe diarrhoea, a skin rash or any sudden change in your health, contact your transplant team immediately.

Long term recovery

Many patients reach another important milestone around 100 days after transplantation, although rebuilding the immune system can take up to a year or longer. As your recovery progresses, follow-up appointments usually become less frequent. Your healthcare team will also discuss when you should receive routine vaccinations again, as many transplant recipients need to be re-immunised between six months and two years after transplantation.

Maintaining follow-up care, attending your appointments and communicating with your healthcare team remain important parts of your long-term recovery.