A transplant using your own stem cells
This transplant uses your own stem cells to replace blood cells destroyed by high doses of chemotherapy and other treatments. It is called an autologous transplant or auto transplant.
It's more usual to have stem cells collected from your bloodstream. But some people might have stem cells collected from their bone marrow.
There are different steps or stages of an autologous transplant.
To prepare you for your transplant, you have:
- various tests
- a central line put in
The central line can stay in your vein for many months. So you don't need to have needles in your hand or arm each time you have treatment. You can also have anti sickness medicines and antibiotics through your central line. And your nurses can take blood samples from your line.
As part of your preparation, you might have chemotherapy to get rid of as many cancer cells as possible. This chemotherapy might also help the bone marrow make more stem cells.
Your treatment could mean it is difficult to become pregnant or father a child in the future. Talk to your healthcare team if this is a concern for you. You might be able to store sperm or eggs before starting treatment.
Treatment can cause an early menopause in some women. Sometimes it is possible for women to freeze their eggs or embryos before cancer treatment. But it takes time to stimulate your ovaries to collect the eggs. Your doctor may not want you to delay starting cancer treatment.
Men may be able to bank sperm before starting any treatment.
Ask your doctor and nurse if you're not sure about anything. They can explain what your options are.
You have injections of a growth factor if you are going to have stem cells taken from your bloodstream. Growth factors are natural substances that make the bone marrow produce more stem and blood cells.
You have growth factor before and after a stem cell transplant. You have them as small injections under the skin.
Depending on your situation you have daily injections of growth factor for between 5 and 10 days. Some people have low doses of a chemotherapy drug alongside the growth factor injections.
The chemotherapy and growth factor help your bone marrow make lots of stem cells. These stem cells then spill out of the bone marrow into the bloodstream.
Side effects include itching around the injection site. Some people have a high temperature (fever). You might have pain in your bones after you have had a few injections. This is because there are lots of blood cells being made inside your bones.
Collection of stem cells
You have stem cells collected from your bloodstream through a drip.
To collect stem cells from your bone marrow, you have a general anaesthetic. A doctor puts a needle into your hip bone to remove the bone marrow.
After your growth factor injections, you have blood tests every day to see if there are enough stem cells in your bloodstream. When there are enough cells, you have them collected. This is called harvesting.
Collecting the stem cells takes 3 or 4 hours. You are awake during this process. You lie down on a couch. Your nurse puts a drip into each of your arms and attaches it to a cell separator machine.
Your blood passes out of one drip. It goes through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood. Your stem cells are collected, frozen and stored.
Having stem cells collected can make you feel very tired. Your calcium level might also get low during your collection, which means you may have:
- tingling around your mouth
- muscle cramps
You may have extra calcium through a drip if this happens.
You have a general anaesthetic when you have stem cells collected from your bone marrow. This means you are asleep and can't feel anything. You have this procedure in an operating theatre.
You lie on your front on a couch. Your doctor puts a needle through your skin into the hip bone (pelvis). The doctor gently draws out the bone marrow through the needle into a syringe. To get enough bone marrow the doctor needs to put the needle into several parts of the pelvis.
You have about 2 pints (1 litre) of bone marrow taken out. This is called harvesting. The cells are then frozen until they are needed.
The procedure takes about an hour. You have the puncture sites covered with plasters. When you wake up you might feel:
- a bit sleepy
- sore and bruised
- more tired than normal for 1 or 2 weeks
You might have to stay in hospital for 1 or 2 nights after a bone marrow harvest. Your nurse will give you painkillers to take home if you have pain.
You have conditioning treatment after your stem cell collection. You have high doses of chemotherapy and you might have targeted drugs, depending on your type of cancer. Your medical team will explain which drugs you are going to have and the possible side effects. You may also have radiotherapy to your whole body. This is called total body irradiation or TBI.
You have chemotherapy and other drugs over about 5 or 6 days. If you have TBI, you might have it at the beginning or end of your chemotherapy.
You have your stem cells back
After treatment you have your defrosted stem cells back. You have these through your central line into your bloodstream.
Blood count recovery
These stem cells find their way back into your bone marrow where they make the blood cells you need. This recovery of blood cells is called engraftment.
You have regular blood tests to check when your bone marrow starts to make new blood cells. The time it takes for the new blood cells to appear (and blood counts to recover) can vary. This might take 1 or 2 weeks and sometimes longer. It can take between 2 to 3 weeks.
During this time, you continue to have treatment for any side effects and symptoms. This might include:
- antibiotics and antiviral medicines to treat and prevent infection
- platelet transfusions if the number of platelets in your blood are low
- blood transfusions if your red blood cells are low
- medicines to relieve a sore mouth, diarrhoea and sickness
After consolidation treatment, you have low numbers of blood cells for some time. This means you are at risk of picking up infections.
You may stay in hospital until:
- your blood cells have recovered enough to go home
- you no longer have any severe side effects
This may take 3 to 4 weeks, although it can vary from one person to another.
Some people become outpatients straight after their stem cell transplant. This is more likely if you have a transplant using your own stem cells. You need to attend the hospital daily for blood tests and treatment. You only stay in hospital if you develop complications.
Outpatient transplant treatment is becoming more common.
You might have a single room in the hospital ward to help protect you from infection. This is called being in isolation. This is less likely to happen with people who have their own stem cells. This is because the risk of infection is lower compared to people who have a transplant using donor stem cells.
While you are in isolation you can have visitors, but your nurses may suggest that you only have one or two each day. Your friends and relatives should not come to see you if they are not well. Or if they have been in contact with anyone with an infectious disease. You might need to follow a special diet including foods that are less likely to give you an infection.
Staying in a single room in hospital can feel lonely. Some people find it frightening. It can help to talk to the nurses about your worries. They can reassure you.
Taking in some of your personal things can make the room feel more homely. Books and photos can brighten it up. You can also take in a laptop, tablet, mobile and music. This can help the time to pass and you can keep in touch with friends and family.
Side effects of transplants
The possible side effects of a stem cell transplant are caused by high dose treatment and total body irradiation. These treatments lower the number of the different blood cells. Side effects include:
- increased risk of getting an infection
- tiredness and lacking energy
- increased risk of bleeding
- sickness and diarrhoea