Information for Related Blood Stem Cell Donors

Please read the following information carefully. Discuss it with your friends and relatives if you wish. Ask us if there is anything you do not understand or if you would like more information. 

You have been selected as the person most suitable to donate stem cells for a relative who has leukaemia or another disease which causes bone marrow failure, and which requires treatment by blood stem cell transplantation. 
 
Blood stem cells, found in the bone marrow, are the source of all blood cells, they can develop into white cells, red cells, and platelets. Stem cells may be collected either directly from the bone marrow or from the bloodstream (peripheral blood) using special techniques.

1. Stem cells sourced from the bone marrow

1.1 Bone marrow harvest procedure

Bone marrow has been used for many years for donor blood stem cell transplants. It is collected (or ‘harvested’) under general anaesthesia from the hip bones of the donor. If you agree to donate bone marrow, arrangements will be made to admit you to hospital, usually for 1 to 2 days.

The procedure will be undertaken in an operating theatre where you will receive a general anaesthetic. While you are under the anaesthetic, a specialist collection team will use syringes and needles to remove blood and bone marrow (which has a consistency not very different from blood itself) from your hip bones.

The whole procedure lasts about one hour. You will then wake up and be returned to your hospital bed. Donors typically leave the hospital 12 – 24 hours after the procedure.

Please note that bone marrow harvests are only undertaken in certain accredited hospitals and are not currently performed in Liverpool. If you are donating bone marrow, the procedure will take place at a hospital in Manchester. 

1.2 Possible complications of bone marrow harvest

You will feel some pain at the sites from which the bone marrow has been removed, but this is only likely to occur for a few hours after the operation, and you will be given any necessary pain relief. It may take a few days before you feel completely normal. Some discomfort, stiffness and bruising will last for about a week, and it is not unreasonable to take a full week off work or from normal activities following the day of the harvest. Very occasionally some backache can persist for several weeks.

The harvest procedure itself is very safe. You must nevertheless be aware that general anaesthesia carries a small risk of subsequent ill-health and even of death. The risk of death associated with anaesthesia is estimated at 1 in 100,000 cases in all patients undergoing surgery. Such patients generally also have an underlying illness, possibly increasing the risk. The risk associated with anaesthesia in a normal healthy donor is therefore expected to be lower than average. 

Occasionally donors are asked to donate stem cells from the bone marrow for the same patient on a second occasion. Alternatively, a second donation of either stem cells or lymphocytes from the bloodstream may be requested (see section 3).

2. Stem cells collected from the peripheral blood

It is now possible to collect the stem cells needed for transplantation from the bloodstream. To do this, it is necessary to administer 4 to 5 injections of a growth factor called G-CSF (see below). This causes stem cells to appear in large numbers in the blood where they can be collected from you using a machine called a cell separator. This effect of G-CSF is often referred to as ‘mobilisation’.

2.1 Mobilisation of stem cells using G-CSF

G-CSF, or Granulocyte-Colony Stimulating Factor, is one of many growth factors produced by the body to help to produce new blood cells to replace those that are lost, principally through their natural ageing process. G-CSF is so called because it stimulates the manufacture of granulocytes which are the most common type of white cell present in the circulation. It also causes stem cells to increase in number and to migrate from the bone marrow into the bloodstream. 

2.2 Procedure for giving G-CSF

G-CSF is given as an injection under the skin in the tummy region, thigh or arm, once a day for a period of 4 – 5 days with the collection of stem cells usually starting on the fifth day. Whilst having the injections you should not play sport or undertake excessive exercise. 

2.3 Possible complications of G-CSF

G-CSF is administered to volunteer donors as a short course - lasting four to five days – and is generally very safe..  More than 10,000 volunteer unrelated donors and many more donors related to patients have received short courses of G-CSF without evidence of harmful side-effects, except on very rare occasions.

The most frequent short-term side effect associated with G-CSF is bone and/or muscle pain, which is usually mild and can be controlled with paracetamol or other products that do not contain aspirin.  

Less common side-effects of G-CSF include insomnia, headache, fatigue, nausea, vomiting and flu-like symptoms including night sweats.  

There have been a small number of cases worldwide of donors having G-CSF and developing a rupture of their spleen requiring treatment. This is an extremely rare side effect but as a precaution please avoid strenuous exercise to reduce the risk of this happening. If you experience pain or discomfort under the left ribcage while on G-CSF then please seek medical advice by contacting the Stem Cell Transplant Unit at Clatterbridge on 0151 318 8600.

Less than one in a thousand people who have received G-CSF have been reported to experience allergic reactions. 

In a very small number of people, and usually only after prolonged administration of  G-CSF, temporary abnormalities of liver function and/or skin rashes have been seen.

Inflammation of the eye is a rare side effect. 

The safety of G-CSF has not been assessed for the unborn child. Female donors of child-bearing age will have a pregnancy test as part of the medical assessment before receiving G-CSF; and they are advised to use reliable contraception throughout the course of injections and for one month afterwards.

2.4 Donation of stem cells using a blood cell separator machine (leucapheresis)

This involves having a needle in each arm – one for collecting blood into the machine, and the other for returning blood from which the stem cells have been removed. Occasionally the veins in the arm are not large enough to allow a good flow of blood in which case we may need to arrange for a line to be inserted into a vein in the groin (a ‘femoral line’).

To harvest sufficient stem cells, it is usually necessary to collect for about 3-5 hours. One harvest procedure is normally sufficient but occasionally we need to collect on two consecutive days. The need for a further harvest is determined by laboratory tests on the collection. If a further collection is needed, you will be given another injection of G-CSF that day.

Once all these procedures have been completed, and you have been given refreshments and feel well, you may go home. You will be reviewed at the outpatient clinic the following week.

2.5 Possible complications of peripheral blood stem cell collection 

The possible complications of the blood collection are bruising where the needle goes in and feeling faint (as happens sometimes with ordinary blood donation). The use of an anticoagulant called citrate to prevent your blood clotting while it is in the machine can cause side effects of tingling, nausea and abdominal pain. This can be easily overcome by slowing down the blood flow rate or giving you calcium replacement.

3. Additional procedures

Very infrequently (about 2.5% of cases), mobilisation of stem cells into the bloodstream fails and there may be too few cells collected for the patient to respond well enough to the transplant. In this unlikely event, you may then be asked to consider an immediate bone marrow harvest to supplement the peripheral blood stem cell collection. Alternatively, after sufficient time has passed to assess the response to the transplant (usually 3-6 weeks), you may be asked to undergo a second peripheral blood stem collection.

Occasionally, if there is any sign in the patient of a relapse of disease after the transplant, you may be asked to give a further collection of white cells known as lymphocytes. The collection procedure is the same as for stem cells, but no G-CSF injections are required.

Please note that there is no obligation on you to agree to these additional procedures.

4. Other considerations

In some cases, the outcome of the transplant is not greatly influenced by whether the stem cells are from the blood or bone marrow. In other cases, the source of stem cells is very important to the outcome and your relative’s doctor will have said that either bone marrow or peripheral blood is preferred. Depending on this you will be asked to give either bone marrow or peripheral blood or asked to state your preference.  

To protect the health of both donor and recipient, all donors, whether giving bone marrow or blood stem cells, need to pass a medical examination and must have a negative test for HIV, hepatitis B and C, and syphilis. 

If you are in any doubt about donating, you should fully consider the matter before completing the consent form and discuss the question further with a professional person of your choosing – for example your general practitioner or a hospital doctor not involved in the care of your relative. 

You have the right to withdraw your consent at any time. However, the patient for whom you have been selected to donate stem cells will receive intensive treatment beginning 7–14 days before the harvest date and he or she will only recover from this treatment if the transplant proceeds.

5. Contact details

Dr Therese Callaghan, Consultant Haematologist
Telephone: 0151 318 8584 or 0151 268 7013

Leah Credidio, Allogeneic Stem Cell Transplant Nurse Co-ordinator 
Telephone: 0151 318 8637

Angela Milner, Stem Cell Transplant Clinical Nurse Specialist
Telephone: 0151 318 8636

For out of hours medical advice, contact the Stem Cell Transplant Unit, Ward 5 at Clatterbridge Cancer Centre – Liverpool on 0151 318 8600.
 

This information has been reviewed by Cheshire and Merseyside Cancer Voices to check it is easy to understand. Cheshire and Merseyside Cancer Voices is a panel of cancer patients who volunteer to read NHS information to make sure it makes sense to people. They have been brought together by Cheshire and Merseyside Cancer Alliance.