Steps in an autologous stem cell transplant
This is a general outline of a transplant using your own stem cells, but the process varies. Talk to your transplant team about what to expect.
1. Stem cells stimulatedThe first step is to help the body make more stem cells. You’ll usually have a dose of chemotherapy followed by injections of a growth factor drug called granulocyte-colony stimulating factor (G–CSF) for 5–10 days. You can often have these injections at home.
G–CSF helps the stem cells multiply and move out of the bone marrow into the blood. This process is called mobilisation and it takes several days. Blood tests will show whether your blood has made enough stem cells for collection.
2. Stem cells collectedStem cells are collected from your blood via a process called apheresis. You will have a needle called a cannula inserted into a vein in each arm, or you may need a special tube called a central line surgically inserted into your chest or neck.
During apheresis, blood is taken from your body, passed through a machine to remove the stem cells, and then returned to your body. This takes 3–4 hours and is usually done during a day visit to the hospital.
3. Stem cells preservedThe stem cells are processed and frozen using liquid nitrogen. This is known as cryopreservation.
You will have a rest period at home for about a month before the next step.
4. High-dose chemotherapyIn the week before the transplant, you’ll go to hospital for high-dose chemotherapy to kill any remaining lymphoma cells. This will also destroy the stem cells in the bone marrow, making room for new stem cells to grow.
Side effects will be similar to the those of standard chemotherapy but can be more intense. They may include nausea, diarrhoea, mouth sores, flu-like symptoms and high risk of infections.
5. Stem cells transplantedA day or so after you have high-dose chemotherapy, your frozen stem cells are thawed and put back into your body (reinfused) using an intravenous drip. This process is similar to a blood transfusion and takes about an hour.
You may have stomach cramps and feel sick (nauseous), which can be managed with medicines.
6. EngraftmentOver the next couple of weeks, the new stem cells will develop into new blood cells, allowing your bone marrow to recover. This is called engraftment.
In most cases, you will stay in hospital for 1–4 weeks until your blood counts have returned to safe levels and you’re well enough to go home.
Once home, you’ll need check-ups every week or so. Over time, you’ll need check-ups less often.
Dr Abir Bhattacharyya, Bone Marrow Transplant and General Haematologist, Westmead Hospital; Katrina Debosz, Blood Cancer Nurse Practitioner, Institute of Haematology, Royal Prince Alfred Hospital; Taylah Dvorak, Consumer; Erinna Ford, Consumer; Dr Nada Hamad, Senior Staff Specialist, Bone Marrow Transplant and Cellular Therapies, and Clinical and Laboratory Haematologist, The Kinghorn Cancer Centre, St Vincent’s Hospital Sydney; Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Suzanne Hough, Senior Clinical Dietitian, Department of Nutrition and Dietetics, Westmead Hospital; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Samantha Rennie, Social Worker – Haematology, St George Hospital, Sydney.
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