- Non-Hodgkin lymphoma
- Stem cell transplant
- Steps in an autologous stem cell transplant
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 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 enough stem cells for collection.
2. Stem cells collectedStem cells are collected from your blood via a process called apheresis. You may have a needle called a cannula inserted into a vein in each arm, or you may need a special tube (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 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 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, but over time you’ll need check-ups less often.
Sometimes the stem cells will be collected directly from the bone marrow by suction (aspiration) under general anaesthetic. This is called a bone marrow harvest. This is not a common procedure.
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Dr Ian Bilmon, Haematologist, Westmead and Sydney Adventist Hospitals; Dr Anne Capp, Radiation Oncologist, Calvary Mater Newcastle; Rachelle Frith, Clinical Nurse Consultant Haematology, Prince of Wales Hospital; Jason Gardner, Consumer; A/Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Samantha Rennie, Social Worker, Cancer Services, St George Hospital. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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