Female patient in hospital ward with female nurse

What happens on transplant day?

Your stem cell transplant normally happens the day after your conditioning therapy has finished. Many people call this ‘day zero’. On this page, we’ll go through every step of the process so you know what to expect on transplant day.

What’s on this page?

What is conditioning therapy?

Before transplant day you’ll go through a process called conditioning therapy. If you haven’t read our page on conditioning therapy, we recommend taking a look at this information first.

When will my hospital get the stem cells?

If you’re receiving your stem cells from an unrelated donor through Anthony Nolan, one of our volunteer couriers will deliver them directly. Your hospital will receive the cells less than 72 hours after our team collects them.

If you’re having an autologous transplant, then you will have already recently gone through the collection process for your own stem cells.

If you’ve having another type of allogenic transplant, where you receive stem cells from somebody else, then the hospital will already have the stem cells.

To find out more, see our section on different types of stem cell transplants.

Ross and his donor Pascal
Ross and his stem cell donor, Pascal

It’s quite emotional when the stem cells come in. One of the things that sticks out in my memory is the little happy birthday card that Anthony Nolan sent. It was nice to get that. It said it was a new birthday. It’s a day we celebrate now.

Ross, who had a stem cell transplant to treat acute lymphoblastic leukaemia (ALL)

What happens before my stem cell transplant?

On transplant day, or ‘day zero’, your nurse will:

  • check your heart rate blood pressure and temperature
  • give you an antihistamine and a small dose of steroids via your central line.

This will help to stop any allergic reaction during the infusion of your new stem cells.

What happens during my stem cell transplant?

During your stem cell transplant, the cells will be passed as a fluid through your central line in the same way as a blood transfusion.

You shouldn’t feel any pain and you’ll be awake the whole time. It can take between 30 minutes and a few hours.

I managed to watch the transplant but I was sick throughout it, and then I fell asleep. I woke up and it was all done

Diana, who had a stem cell transplant to treat acute lymphoblastic leukaemia (ALL)

When the infusion has finished, your nurse will flush your line through with saline (a type of salty water) to keep it clean. They will then check your heart rate, blood pressure and temperature again. Once they’ve done their final checks, your transplant is complete.

People have lots of different feelings about and experiences of transplant day. For some of us it’s a celebration of a new beginning. For others it can feel like an anti-climax, because something so important is over so quickly and simply.

You might experience all sorts of emotions after your transplant

However you’re feeling is completely valid. But you can talk to your transplant team if you’re experiencing any difficult feelings.

Rupert_2018_DSC04453
Holly and Rupert

The transplant itself was very uneventful, just like having a blood transfusion. I was very excited and relieved when it was happening, but my son (who was having it) slept through the whole thing.

Holly, whose son Rupert had a stem cell transplant to treat myelodysplastic syndromes (MDS) with monosomy 7

What medication will I need to take?

You’ll take different medications to help you through your transplant and your recovery. You might take some as tablets, or doctors might give you others through your central line.

These medications often have names which might be difficult to say, and it might be hard to remember each of their purposes. In general, the medication you take should come under one of these five categories:

  1. To help engraftment happen more quickly. Engraftment is the forming of your new blood cells. You might hear these types of medication called ‘growth factors’, which you’ll usually get as an injection.
  2. To help control your new immune system and reduce the effects of graft versus host disease (GvHD).
  3. To protect you from bacterial infections. You might hear these types of medications called ‘antibacterial prophylaxes’.
  4. To prevent viral infections, like shingles, for example. You might hear these types of medications called ‘antiviral prophylaxes’.

To control other symptoms and side effects. For example, taking medications to protect your kidneys, to prevent nausea and vomiting, or a type of antifungal prophylaxis. You might also need to take other medication depending on blood results during your treatment.

Nigel and his daughter

My daughter Caitlin took a photo of the cells going in. To be honest it’s just a normal day, it’s a transfusion just like all the ones I’d had before. But goodness, it makes a difference!

Nigel, who had a stem cell transplant to treat acute myeloid leukaemia (AML). You can read his story on our blog.

What happens after engraftment?

After the transplant, your new stem cells travel in your bloodstream to your bone marrow. Once there, they attach themselves and start to produce white blood cells that will form your new immune system. You’ll usually hear this called 'engraftment'. It generally means things are going well and your transplant has worked.

What happens in a stem cell transplant?

If you haven’t read our pages on understanding the transplant process, we recommend taking a look at this information first.

Engraftment normally takes around two to three weeks, but can sometimes take longer. The first sign of successful engraftment is often an increase in your white blood cell count.

As your medical team will test your blood regularly, they know when engraftment has started – they should see a steady increase in your white blood cell count. During this time, you might need blood and platelet transfusions a few times a week. This helps ‘top up’ your red blood cells, which may also be low. These extra transfusions are a normal part of recovery and don’t mean your transplant hasn’t worked. If you do have concerns, you should talk to your medical team.

Patient Jo Kelly - with donor Stefan and daughter Phoebe
Jo with her stem cell donor, Stefan, and her daughter

For a few days you’re just waiting for those stem cells to just kick in and become new healthy blood cells… You’re literally starting from scratch. The best way I can describe it is, you’re pushed to the point of near death, and then you’re brought back again.

Jo, who had a stem cell transplant to treat Hodgkin lymphoma

Last updated: 06/09/2024

Next review due: 06/09/2027