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From diagnosis to post-transplant care, here is what to expect during stem cell transplant. Haematopoietic stem cell transplant, more widely known as stem cell transplant, is a procedure used to treat specific cancers. While it offers hope for long-term remission or even a cure, the journey is complex, both physically and emotionally.

WHAT TYPES OF CANCERS ARE TREATED WITH STEM CELL TRANSPLANT?

Patients with acute leukaemia, lymphoma and multiple myeloma can be treated with stem cell transplant. Some non-blood cancers such as neuroblastoma and testicular tumours can also be treated with stem cell transplant.

HOW DO STEM CELLS FIGHT CANCER?

Stem cells do not fight cancer cells directly. Instead, they restore your bone marrow’s ability to produce new healthy blood and immune cells. Patients will suffer fewer side effects from chemotherapy if stem cell rescue is delivered following chemotherapy.

WHAT DOES THE STEM CELL TRANSPLANT JOURNEY LOOK LIKE?

The patient is first diagnosed with blood cancer. The haematologist will determine the treatment plan based on the specific subtype of blood cancer. If chemotherapy alone is proven not to be optimal in the course of treatment, stem cell transplant will be offered as part of the treatment plan. The patient will almost always receive chemotherapy or other form of therapy first to control the blood cancer before undergoing the stem cell transplant.

There are two types of stem cell transplant: autologous vs allogeneic.

Autologous stem cell transplant uses the patient’s own stem cells. The purpose is to lessen the side effects of high dose chemotherapy which is needed to treat the cancer, such as lymphoma or multiple myeloma. Patient’s own stem cells will be collected before the patient receives chemotherapy.

Allogeneic stem cell transplant uses a healthy donor’s stem cells. The purpose is to give the patient a new blood and immune system to fight the remaining cancer cells which cannot be fully eradicated with chemotherapy alone. A healthy suitable donor is needed in this setting.

HOW LONG WOULD THE PATIENT BE HOSPITALISED AFTER THE PROCEDURE?

The patient needs to be admitted to the hospital to undergo stem cell transplant. The patient receives chemotherapy during the initial phase, called “conditioning chemotherapy”. This is to eradicate the remaining cancer cells as well as prepare the patient to receive the stem cells without rejection. Stem cells are infused when the patient is ready, which happens in the first week of the hospitalisation. The patient stays in the hospital till the recovery happens in about two to three weeks after the stem cell infusion.

WHEN WILL THE PATIENT REGAIN NORMAL FUNCTION?

The patient comes to the outpatient clinic for further check-ups after the discharge. The blood counts and organ functions will be monitored closely. Anti-viral and anti-fungal drugs are prescribed to prevent infections. Immunosuppressant drugs are prescribed in the setting of allogeneic stem cell transplant to prevent graft failure or graft-versus-host-disease.

The recovery to the functional baseline takes about two to three months in the setting of autologous stem cell transplant and three to six months in the setting of allogeneic stem cell transplant.

The medications are tapered and stopped during this period. The patient’s immune system remains weak for six to 12 months post stem cell transplant. Hence, the patient is advised to observe personal hygiene procedure, avoid crowded places, and to seek medical attention if unwell.

HOW CAN PATIENTS PREPARE THEMSELVES FOR STEM CELL TRANSPLANT?

Medical Preparation

• Vaccinations: Patients may need to be updated on immunisations before therapy.
• Dental check-ups: Any necessary dental procedures should be done before the treatment to reduce the risk of infection.
• Fertility preservation: Chemotherapy and radiation may affect fertility; options like sperm or egg freezing should be discussed early.
• Medical tests: Blood tests and organ assessments such as a heart scan will be carried out to ensure you are well enough to undergo the therapy.

Lifestyle Adjustments

• Nutrition: Eating well before the procedure can improve recovery outcomes. Dietitians may recommend a high-protein, high-calorie diet.
• Physical fitness: Even light activity before treatment can help patients withstand the rigours of chemotherapy and hospitalisation.
• Home environment: Post-discharge recovery requires a clean, low-risk setting. Patients may need to prepare their homes by minimising dust, limiting visitors, and arranging for caregiver support.

Mental Readiness

• Having a clear understanding of what to expect can reduce anxiety. Education sessions and meetings with transplant coordinators help demystify the process.

Patients are encouraged to identify a caregiver or primary support person to accompany them through the process, from hospital visits to emotional support.

WHAT ARE SOME COMMON CHALLENGES FACED DURING THE JOURNEY?

Stem cell transplant is not only taxing on the body. It also takes a psychological toll. Here are some common physical and emotional challenges patients face:

Physical Challenges¹

Fatigue: Often persistent and may last for months.

• Infections: The immune system is severely compromised post-transplant.
• Mucositis: Painful sores in the mouth and digestive tract caused by chemotherapy.
• Gastrointestinal issues: Nausea, vomiting, and diarrhoea are common.
• Graft-versus-host disease (GvHD): In allogeneic transplants, this serious complication can affect the skin, liver, and gut.
• Organ damage: High-dose chemotherapy can lead to long-term effects on the heart, lungs, or kidneys.

Emotional and Psychological Challenges

• Isolation: Due to infection risk, patients are often cut off from normal social interactions.
• Anxiety and depression: Uncertainty about outcomes, fear of relapse, and changes in physical appearance (e.g., hair loss) can impact mental well-being.

Many treatment centres now offer counselling, peer support groups, and mindfulness-based therapy to help patients navigate these emotional hurdles.

While stem cell transplant presents considerable challenges, it also offers hope of recovery and renewed life for patients battling serious conditions. Knowing what to expect and preparing for both the physical and emotional demands can empower patients to navigate this journey with greater confidence.

The path may be long, but with coordinated medical care, strong support systems, and resilience, many patients emerge not just survivors, but stronger than before.

¹ https://www.parkwaycancercentre.com/sg/treatments/stem-cell-therapy#Benefits-And-Risks