What's involved in high-dose treatment with stem cell support
There are four main steps in the process of high-dose treatment with stem cell support. Here we give a brief explanation of what’s involved in having high-dose treatment with stem cell support. It’s explained in more detail in our information on being treated.
Your specialist, nurse or transplant coordinator will explain why a stem cell transplant is advised and what the possible benefits and risks are.
Treatment is given to reduce the amount of leukaemia or cancer.
Chemotherapy to treat the cancer (induction treatment)
You’ll have treatment with chemotherapy, and possibly radiotherapy, to reduce the amount of cancer or leukaemia as much as possible. This is called induction treatment. Ideally there shouldn’t be any signs of the cancer (this is called remission) at the time of your high-dose treatment. This gives the treatment the best possible chance of working. In some situations though, high-dose treatment may be done if there’s still a small amount of cancer present.
Stem cells are collected and stored until needed (this is called harvesting).
Collecting the stem cells
The second step is the collection of the stem cells, which is known as the harvest. Your stem cells can be collected and stored if you don’t need high-dose treatment straight away but might need it in the future – this is sometimes called a ‘rainy day’ harvest. Or they can be collected a few days or weeks before your high-dose treatment.
High-dose treatment is given to remove any remaining leukaemia or cancer cells (this is called conditioning).
The third step is the high-dose treatment, which is given to remove any remaining cancer cells from your body. You may have high-dose chemotherapy alone or with radiotherapy. This intensive treatment will destroy most or all of the blood cells in your bone marrow. This step is sometimes called the conditioning treatment and usually lasts a few days. It may make you feel unwell, but you’ll be given drugs to help control side effects such as feeling sick (nausea) or being sick (vomiting). These drugs may make you feel sleepy.
The infusion of stem cells is given.
Having the stem cell infusion
After your high-dose treatment, your own stem cells are given back to you through a drip (infusion). This is a bit like having a blood transfusion.
It usually takes at least two weeks before the cells start to make new blood cells. You’ll needs lots of medical and nursing support until the numbers of blood cells have returned to a safe level. While your level of healthy blood cells is low, you may need antibiotics. This is because you’ll have very little resistance to infection. You may also be given injections of growth factors (G-CSF) to help your bone marrow make new white blood cells more quickly. You’ll probably be looked after in a room of your own to protect you from infection. You will also usually need to have blood and platelet transfusions.
Risks of high-dose treatment
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High-dose treatment with stem cell support is a complex and specialised treatment. It has many side effects and possible complications. You may need to stay in hospital for up to six weeks or longer, and there are likely to be times when you feel very unwell.
Your doctor will take into account your age and general health before advising you to have this treatment. Guidelines recommend an upper age limit of 70 because the risks of severe side effects are higher after that age. But the age limit can be flexible depending on your general health, the risk of side effects and the risk of the cancer coming back.
The main risks are serious infections and bleeding, which are most likely to happen when your blood counts are low.
Unfortunately, infertility (being unable to have children) is usually a side effect of high-dose treatment. It’s important to talk to your specialist doctor or nurse about any concerns and options for preserving your fertility before treatment starts.
Questions you might like to ask your doctor
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What are the possible benefits of high-dose treatment with stem cell support for me? What are the risks?
Are there long-term side effects?
Will I be able to have children after treatment?
How long will it be before I can start to live my normal life again?
What happens if my cancer comes back after I have high-dose treatment?
You may also want to ask questions about what may happen if you decide not to have the treatment:
What other treatments can I have?
What is likely to happen with my cancer?
Will I be able to go on with my normal life?
You’ll need to weigh up the benefits and risks of this treatment very carefully when making your decision. It’s important to discuss these questions with your specialist, who will make sure you’re fully aware of the possible benefits and risks of the treatment. You’ll probably need some time to talk things over with your family and close friends. Most units have a nurse specialist, a transplant coordinator, social worker or a counsellor who you can talk to. We have more information about making treatment decisions.
Giving your consent
Before you have any treatment, your doctor will explain its aims. They’ll ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain it again. High-dose treatment with stem cell support is a complex treatment, so it’s not unusual for people to need repeated explanations.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions