Autologous Stem Cell Transplant

What is an autologous stem cell transplant?

An autologous (pronounced “ah-tah-luh-gus”) stem cell transplant uses your own blood stem cells to restore your bone marrow’s ability to make the cells. It’s treatment for some types of blood cancer.

In an autologous stem cell transplantation, your healthcare team removes healthy blood stem cells before you receive high doses of chemotherapy to kill cancerous cells. You may also receive radiation therapy.

The same treatment that gets rid of cancerous cells also kills healthy cells. It can also damage your bone marrow so it stops making blood cells. An autologous stem cell transplant is how you receive healthy blood stem cells so your bone marrow can make new, healthy blood cells.

This procedure may not cure cancer. But research shows it can put cancer into long-term remission, meaning you don’t have symptoms and tests don’t find signs of cancer. It’s also an option when other treatments don’t work (refractory cancer) or the cancer comes back (recurrent cancer).

What does this procedure treat?

Healthcare providers most commonly use autologous stem cell transplantation as the initial (first-line) treatment for multiple myeloma. In this condition, cancerous plasma cells in your bone marrow multiply and make abnormal proteins.

This procedure may be used to treat Hodgkin lymphoma and non-Hodgkin lymphoma if other treatments aren’t effective or the conditions come back after treatment. Autologous transplants can also be used for treatment-resistant germ cell tumors and some autoimmune diseases in the treatment-resistant setting.

What happens before an autologous stem cell transplant?

The first step before an autologous stem cell transplant is to check on your overall health (apart from your blood cancer). High-dose chemotherapy can cause significant side effects. It also increases your risk of serious infections.

Tests before the procedure

Your healthcare provider will order tests, including:

• Electrocardiogram (EKG).
• Echocardiogram.
• Computed tomography (CT) scan.
• Complete blood count (CBC).
• Blood tests, including liver function or kidney function.
• Biopsy to study cancerous cells.

Before your blood tests, your provider may place a central venous catheter (CVC) in one of the large veins in your upper chest. Having a CVC means you can avoid repeated needle sticks to draw blood or to insert intravenous tubes throughout the transplant process.

Growth factor medication

Once you’re cleared for transplant, you’ll receive growth factor drugs. Growth factors are hormone-like substances that help your bone marrow make more blood cells. You’ll receive other drugs that help move your blood cells from your bone marrow into your bloodstream. Your provider may call this process “mobilization.”

What happens during an autologous stem cell transplant?

There are three steps in the process:

• Collecting (harvesting) and processing your stem cells.
• Preparing you to receive stem cells (conditioning).
• Transplantation (infusion).

Stem cell collecting (harvesting)

In stem cell collection, providers take blood from you so they can remove healthy blood stem cells for transplant. This is apheresis. Here’s how it works:

• Providers connect veins in both of your arms to a cell separator (centrifuge) machine.
• The machine pulls blood from the veins in one arm.
• Blood flows into the cell separator machine, which filters out stem cells.
• Blood then flows back into veins in your other arm.

The harvesting process doesn’t hurt but can take three to four hours, as your providers may need to take blood more than once to be sure they have enough stem cells to transplant. You’ll need to lie still during the collection process, but you’ll probably be able to read or watch television.

Conditioning

This is when you receive high doses of cancer-killing chemotherapy and radiation therapy. Conditioning treatment for an autologous stem cell transplant may take place over several days. During that time, your healthcare team will keep a close eye on your overall health and treat any side effects you may have.

Possible short-term side effects of conditioning may include:

• Anemia from low red blood cell levels.
• Bleeding issues from low platelet levels.
• Diarrhea.
• Fatigue.
• Loss of appetite and dysgeusia (changes in sense of taste).
• Hair loss.
• Nause and vomiting.
• Mouth sores.
• Weight loss.

Potential long-term side effects may include:

• Bone damage (osteoporosis).
• Cataracts.
• Early menopause.
• Infertility.
• Interstitial lung disease.
• Second cancer, which is when you develop a new type of cancer.

Transplantation

Receiving your stem cells may look and feel a lot like receiving medication or a blood transfusion: Your stem cells flow into your body through an intravenous catheter (IV) or CVC. Before that, however, your provider will give you fluids and medications to help prevent side effects. Then, they’ll start infusing stem cells. The process may take several hours. While you’re receiving new stem cells, your provider will frequently check for signs of fever, chills and other potential side effects.

What happens after an autologous stem cell transplant?

Here’s what’s going on in your body during recovery:

• Your stem cells travel through your bloodstream to your bone marrow where they’ll start to make new blood cells. This is engraftment.
• Until engraftment occurs, you’re at increased risk of serious infections until your bone marrow produces more white blood cells.
• You may receive growth factor injections to speed up engraftment.
• Each day, your healthcare team will check your blood cell and platelet levels for signs that the transplanted stem cells are making new blood cells and platelets.

What are the benefits of autologous stem cell transplants?

If you have multiple myeloma, an autologous stem cell transplant may be the only treatment you need to put the condition into long-term remission. If you have Hodgkin lymphoma or non-Hodgkin lymphoma, this procedure may give you a second chance to overcome cancer when other treatments aren’t effective or the cancer comes back.

What are risks or complications of autologous stem cell transplants?

The most significant risk is developing a life-threatening infection after the procedure. That’s why it’s very important to protect yourself from infection.

Success rate

The success rate of autologous stem cell transplants and procedure survival rates depend on various factors, such as your diagnosis and how severe your condition is.

Other variables include other medical issues you might have and how well you tolerate chemotherapy. Ask your healthcare provider about your prognosis, or what you can expect after treatment. They’ll be glad to explain how success rates and survival rates apply to you.

What is the recovery time?

Even though your bone marrow is making new blood cells, it may be three to 12 months before your immune system fully recovers after an autologous stem cell transplant. It may be four months before you’re ready to go back to work if you work outside the home or to school, but everyone is different. Here are some suggestions that may help you along the road to recovery:

• Get rest: You may have days when it’s exhausting to make it through your day. Rest when you need to, not just when you think you can.
• Eat well: Your body needs to recover from conditioning treatment, and meals packed with protein will help. Ask to speak with a nutritionist if you want to make sure you’re getting enough nutrients.
• Make regular physical activity part of your day: As you feel stronger, you can start doing things like taking a walk. But be sure to talk to your provider before starting anything new, and don’t push yourself once you start.
• Update your vaccinations: An autologous stem cell transplant will wipe out any protection from your past vaccinations, including your childhood vaccinations. Your healthcare provider will explain when you should start your shots, but you may be able to have inactive vaccines six months after your transplant and live vaccines in two years.

When should I call my healthcare provider?

You’ll have regular follow-up appointments with your care team. They’ll keep an eye on your overall health. But you may have symptoms that could be signs of treatment complications. Contact your healthcare provider as soon as possible if you have symptoms like:

• Fever.
• Chills.
• Shortness of breath (dyspnea).
• Coughing, sneezing or runny nose.
• Frequent urination or painful urination (dysuria).
• Rash.
• Lightheadedness/dizziness.

What’s the difference between an autologous stem cell transplant and an allogeneic stem cell transplant?

An allogeneic stem cell transplant uses donated stem cells, while an autologous one uses your own stem cells. An allogeneic stem cell transplant may be an option if you have a condition that affects your blood stem cells, but you don’t have enough healthy stem cells for an autologous stem cell transplant.