An autologous stem cell transplant uses stem cells from your own body in treatment. In some cases, if you have enough healthy stem cells, the doctors can separate the healthy cells and save them, then put them back into your body to replenish and help fight the disease.
During an autologous stem cell transplant, your own stem cells are collected and stored for use later on. This works best when you still have enough healthy stem cells, even though you're sick. If you have cancer, the cancer cells are removed or destroyed from the collected cells. Most patients undergoing an autologous stem cell transplant are suffering from a malignant disease that is sensitive to chemotherapy. It is believed that administering a much higher dose of chemotherapy will result in a better chance of your cancer remaining in remission.
To treat your cancer more intensively, higher doses of chemotherapy are needed. Radiation of a part or all of your body may be part of your treatment. Both the high-dose chemotherapy and the radiation will suppress and damage your bone marrow. Inside the bone marrow reside the stem cells, which are the "mother" cells that can produce all the cells that you find in your blood: the red cells, platelets, and white cells. High-dose chemotherapy and/or radiation lead to damage of the stem cells, resulting in low levels of red cells, platelets, and white cells. Consequently, the patient is at risk for anemia, bleeding and infection.
A stem cell transplant is done to restore the stem cells, which in turn can produce sufficient white cells, platelets, and red cells to protect you from long-term complications. In your case, your physicians feel that the use of your own stem cells would be more beneficial than the use of stem cells from a donor.
In general, an autologous stem cell transplant is safer and simpler than an allogeneic (donor) stem cell transplant. It relies completely on the efficiency of the chemotherapy and radiation ("preparative regimen") to kill the cancer cells. Since you are both donor and the recipient, no immunological differences exist. The new stem cells will not attack the cancer, but they won't attack your body either.
Stem cells are mostly obtained from the blood stream ("peripheral blood stem cells"). In order to push stem cells from the bone marrow to the blood stream, a "mobilization treatment" is done. You will either receive: daily injections (like insulin shots) of a growth factor (e.g, Neupogen®) for four days, followed by daily stem cell collections moderately high-dose chemotherapy, followed by daily injections of a growth factor. In this case, collections will not start until 11 to 14 days after the chemotherapy. In the meantime, your white cells and platelets may be very low, and you are at risk for infection and bleeding. Collections will be done with an apheresis machine, which is a blood separator. You will be connected to the machine through a large-bore catheter, which will be inserted on the first day of collections. Each collection takes 3 to 5 hours. To obtain sufficient stem cells, between 2 and 5 daily collections are necessary. Each collection will be checked for its stem cell content, and once the threshold goal is reached, the collection process is stopped. Transplant therapy after stem cells have been collected, the patient is ready for the start of the actual transplant therapy. Depending on the disease, either: 3 days of radiation (TBI) are given, followed by 1 to 4 days of chemotherapy. The radiation is given twice a day for a total of six doses. or only 2 to 6 days of chemotherapy are used. The chemotherapy may consist of only one drug, or of a combination of drugs. Your physician will discuss with you which drugs will be used and when. Additional drugs may be administered to prevent nausea from chemotherapy, infections or complications from the chemotherapy drugs. Many are given by mouth, some are given by vein. You will also receive lots of fluid by vein to remove the waste products as rapidly as possible. Stem cells re-infused Two days after the last chemotherapy, your stem cells will be re-infused. After collection, the stem cells were stored in bags in liquid nitrogen to keep them viable. Now they will be thawed at the bedside in a water bath, until they are liquid again. Then the stem cells will be slowly injected with a syringe into your central line. The process lasts 15 to 30 minutes. Possible side effects include allergic reactions to DMSO, a chemical added to the stem cells to prevent damage during freezing. The possible allergic reactions are quite benign, and can often be prevented or treated with drugs such as Benadryl®.
After the re-infusion of stem cells, the wait is on for the growth of new blood cells. It takes about 8 to 10 days before the first white cells re-appear. In the meantime, the "old" blood cells will start dying off, and patients will be prone to infections and bleeding. You will probably need transfusions of platelets and red cells. Once the white cells and platelets re-appear, they mostly return rapidly to the normal range. Transfusions are usually only needed in the first 2 to 3 weeks after transplant.
After an autologous stem cell transplant, most patients are back to work after 4 to 6 weeks. At times energy levels may still be low, appetite may vary, and emotionally patients may feel up and down. The IBMT nurses and physicians, the social worker, and the oncology chaplain are available for any help you may need.If you have additional questions or concerns, we encourage you to discuss them with your Indiana Blood & Marrow Transplantation physician, the clinic nurses or the transplant coordinator.