Introduction

Patients with a haematological malignancy such as leukaemia, lymphoma and myeloma may undergo a haemopoietic stem cell transplant as part of their cancer treatment. This is a highly specialised procedure and is undertaken in a specialised transplant unit. If you have been allocated to a specialist transplant unit, you will have the opportunity to observe and experience high-intensity transplants and learn to care for acutely sick patients. If you have not been allocated to this area, you may be able to arrange an insight visit. Whether you get the opportunity to visit a haemopoietic transplant unit or not, you may meet individuals who are either preparing for the procedure or who have undergone the treatment. Increasingly, low-risk haemopoietic stem cell transplants are being performed in more general areas such as the community setting (Dix & Geller 2000). This requires community-based healthcare professionals to be knowledgeable and skilled in caring for these patients. Although the transplant phase is very intensive and patients can become critically unwell, patients require long-term support so you may meet these patients during the post-transplant phase.

Haemopoietic stem cell transplant is the use of high-dose cytotoxic therapy (with or without radiotherapy) and a transfusion of haemopoietic stem cells to ‘rescue’ the patient’s haematological status. Previously, bone marrow was used in transplants, extracted from the iliac crest under local anaesthetic. This was painful and intrusive. To avoid this, stem cells are now used. Stem cells are the cells that develop into, or differentiate into, all types of blood cells – red and white cells and platelets – and can easily be accessed peripherally.

There are three types of haemopoietic transplant, depending on where the stems cells come from:

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