What is an autologous stem cell transplant?

An autologous stem cell transplant allows you to have much higher doses of chemotherapy than usual to treat the cancer.

You usually have standard-dose treatment first to get rid of as many cancer cells as possible. After this, you have high-dose treatment to destroy any remaining cancer cells. But high-dose treatment destroys the stem cells in your bone marrow as well as the cancer cells.

Because of this, some of your stem cells are taken and stored before you have high-dose treatment. After the treatment, they are given back to you through a drip (infusion). Your stem cells make their way to your bone marrow and start making new blood cells. Without this it could take many weeks or months for your blood count to recover.

Reasons for having an autologous stem cell transplant

An autologous stem cell transplant increases the chances of curing certain cancers, such as lymphoma. Or it can help keep certain cancers, like  myeloma, in remission for as long as possible. Remission is when there are no signs of the cancer.

This treatment may be used when:

  • there is a higher risk of the cancer coming back without it
  • the cancer has come back after other treatment
  • the cancer has not responded completely to treatment.

It is an intensive treatment. But it is less complicated than using stem cells from a donor. There are fewer problems and recovery is faster.

Deciding to have an autologous stem cell transplant

Your cancer doctor, nurse or transplant co-ordinator will explain why you are being offered this treatment. They will tell you about the possible benefits and risks.

You need to think about the benefits and risks of this treatment carefully before you decide. It is important to discuss any questions you have with your cancer doctor. You may want to talk about it with family and close friends. Most units also have a nurse specialist, a transplant co-ordinator, a social worker or a counsellor who you can talk to.

Some people find it helps to talk to someone who has already had this treatment. Talk to the staff at the hospital where you are having your treatment. You can also use Macmillan’s Online Community to meet people who are going through similar experiences to you.

We have more information on making treatment decisions that might help. This includes information about getting a second opinion and giving permission (consent) for the hospital staff to give you the treatment.

It is important to think about the issues below. 

Risks of an autologous stem cell transplant

An autologous stem cell transplant is a specialised treatment. The main risk is serious infections. These are most likely to happen when your blood counts are low.

You usually stay in hospital, or near the hospital if you are having ambulatory care, for 2 to 4 weeks. But some people stay longer. There may be times when you feel very unwell.

Your doctor will consider your general health before advising you whether to have this treatment. This is because your general health can affect your recovery.

Fertility

An autologous stem cell transplant can affect whether you can get pregnant or make someone pregnant . This is a side effect of high doses of chemotherapy and sometimes radiotherapy.

If you are worried about your fertility, it is very important to talk to your specialist doctor or nurse. They can refer you to a fertility specialist to discuss possible options to preserve your fertility.

Research trials

You may be invited to take part in a research trial. Trials and studies are the only reliable way to find out whether a different type of treatment is better than what is already available.

Stages of an autologous stem cell transplant

Stage 1: Getting ready for treatment

Your cancer doctor or nurse explains the benefits and risks of having this treatment. If you decide to go ahead, you have standard chemotherapy to get rid of as many cancer cells as possible. When you have finished this, you have tests to check your general health. This may include tests on your heart, lungs and kidneys.

Stage 2: Collecting the stem cells

This is known as the harvest. Your stem cells are usually collected at least 2 weeks before you have high-dose treatment. They are frozen and stored until they are needed.

Stage 3: High-dose treatment

You are given high-dose treatment to destroy as many cancer cells as possible that may be left in your body. You may have high-dose chemotherapy on its own or with radiotherapy. This destroys most, or all, of the cancer cells. But it also affects healthy blood cells in your bone marrow. This stage is also called conditioning treatment. It can take from one day to one week.

Stage 4: Having the stem cells

After your high-dose treatment, you are given your own stem cells back through a drip (infusion). We have more information about having the stem cell infusion.

Stage 5: Waiting for new blood cells to grow

It is usually between 10 and 12 days before the stem cells start to make new blood cells. Sometimes it may take longer. Doctors call this engraftment. You will need lots of medical and nursing support until your blood count returns to a safe level.

Stage 6: Recovering after your treatment

When your blood count has recovered, and you are well enough, you can go home. Your doctor or nurse will tell you how to reduce your risk of infection and improve your fitness. It may take months to recover from this treatment.

Side effects of an autologous stem cell transplant

The side effects you have will depend on the type of high-dose treatment you had. Most side effects are caused by having low numbers of blood cells. When your blood count goes up, the side effects will start to improve.

Some people may have late effects from chemotherapy. These are side effects you still have 6 months after chemotherapy, or side effects that begin years later. Late effects are not common. Your cancer doctor or specialist nurse can explain more. 

We have more information about the possible side effects of high-dose treatment.

After autologous transplant

Going home

When your blood counts have reached a safe level, your transplant team will talk to you about going home. Before you go home, you will need to:

  • have recovered enough from all your side effects
  • be eating and drinking well
  • be walking about by yourself
  • be able to take your tablets so you do not need drugs through your line.

Follow-up

You will have follow-up appointments to make sure you stay well. The appointments will also check that there is no evidence of the cancer returning. Your doctor or nurse will tell you how often you will have them. Usually you will have a medical examination, blood tests and possibly scans.

These check-ups can be worrying, as you will probably be anxious about whether the treatment has worked. It often helps to take a relative, friend or partner, if you have one, with you for support. The check-ups are a good chance to talk to your doctor or nurse about any worries or problems you have.

When to contact the hospital

Always carry the 24-hour hospital phone number you have been given. If you are worried about anything, call the number at any time of day or night.

It is important to take care of your health during this time. Your doctors and nurses will give you advice about what precautions you will need to take once you are home.

Contact your hospital straight away on the number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have any signs of an infection – such as feeling shivery or short of breath, having a sore throat or cough, having diarrhoea or needing to pass urine often
  • you have been in contact with someone who has an infectious disease, for example chickenpox or measles
  • you cannot take your tablets.

It is important to follow any specific advice your cancer treatment team gives you.

If you feel unwell and are unable to contact the hospital, ask someone to take you to the nearest hospital accident and emergency (A&E) straight away.

Recovering from an autologous stem cell transplant

After you go home, you will need to go back to your local hospital outpatient clinic for checks. To begin with you may have 1 or 2 appointments close together. After that, you will have them less often.

Your immunity will be low for a few months. This is even after your bone marrow has recovered and your neutrophils (white blood cells that fight and prevent infection) are back to a normal level.

You may have to take regular antibiotics and anti-viral drugs to reduce the risk of infection.

Many people go on to make a full recovery with few health problems after a transplant. You will have the support of your transplant team or haematology team during your recovery.

Here are some things to be aware of as you recover:

  • Eating and drinking

    Your doctor or nurse can give you information about your diet for when you are home. Follow the advice that they give you.

    While your immune system is recovering, try to eat a healthy and balanced diet. Try to avoid possible risks of infection from food. Once your immune system is back to normal, you can eat whatever you like. Your dietitian or nurse will give you advice.

    Check with your doctor before drinking alcohol. It slows down the recovery of the bone marrow and increases the risk of bleeding. It can also interact with some of the drugs you are taking.

     

  • Managing tiredness

    Feeling you have little or no energy (fatigue) is very common after high-dose treatment. It is usually worse in the 2 to 4 weeks after treatment and then starts to improve. After the first month you can start trying to do a bit more each week. Recovery from treatment is usually gradual and will take time.

  • Becoming more physically active

    Regular, gentle walks help to keep your muscles toned. While your blood count is still recovering, certain types of exercise are not suitable. You can ask your specialist about this.

  • Socialising

    It is important to spend time with family, friends and your partner, if you have one. You should also do things you enjoy. But it is important to ask your team for advice about how to do this safely. They can give you information that is right for you and your situation.

    In general, you should try to avoid crowded places until your immune system has recovered. This includes shops, cinemas and public transport at busy times.

    You should avoid contact with children who have infectious illnesses such as chickenpox or measles. Also avoid people with sickness or diarrhoea. If you are worried you have been in contact with someone with an infectious illness, contact your transplant team. We also have coronavirus (COVID-19) guidance for people with cancer.

  • Driving

    If you feel very tired, you may find it hard to concentrate. This can make you less alert and slow down your reaction time. It is best to avoid driving if you feel like this. Ask someone else to drive you instead. Ask your transplant team if there is help with transport for hospital appointments. Some drugs cause side effects that may make it unsafe for you to drive. Speak to your doctor about any concerns you have.

  • Your sex life

    Your treatment does not stop you being able to have sex. Before going home, check with your doctor if there is any reason you cannot go back to your usual sex life. It can take time for things to go back to how they were before.

  • Contraception

    Chemotherapy may affect whether you can get pregnant or make someone pregnant (fertility). If you have periods they may stop during treatment, but you might still be able to get pregnant. Cancer treatments may harm a developing baby. It is important to use contraception to prevent a pregnancy during cancer treatment and for a time after it.

    Your doctor or nurse will tell you how long you need to use contraception for.

  • Hormone replacement therapy

    Women may have an early menopause because of their treatment. As well as periods stopping, other symptoms include hot flushes and sweats, vaginal dryness, mood and concentration changes, and a low sex drive.

    Most of these symptoms can be helped by hormone replacement therapy (HRT). You can talk to your specialist doctor or nurse about this.

  • Going back to work, school or college

    When your blood counts have recovered, you can ask your doctor about going back to work, school or college. You should do this gradually, by going part-time to begin with. It is a good idea to talk to your employer, teacher or tutor about the best way of returning. Think about whether you want them to tell other people about your treatment before you return.

  • Vaccinations

    After high-dose treatment, you may lose your immunity to illnesses you were vaccinated against as a child. You may need to have some of these vaccinations again.

    You will also need vaccinations to protect you against common infections such as flu and coronavirus. Your specialist doctor may also recommend that the people you live with have some vaccinations, for example, the flu vaccine. They will give you advice about when you should have your vaccinations.

    You need to avoid some types of vaccines (live vaccines) until your immune system is back to normal. Try to avoid contact with young children who have had the flu vaccine as a spray through the nose. If your child has had the rotavirus vaccine that is given by mouth, do not change or handle any dirty nappies. Your specialist doctor will tell you which vaccinations are safe and which ones you should avoid.

  • Holidays and travel

    As your immune system recovers and the time between hospital visits get longer, you might think about going on holiday. Talk to your specialist doctor before booking a holiday. They usually advise you not to travel abroad for a few months after treatment.

    We have information on travel and cancer that has helpful, practical tips about travelling.

  • Sun protection

    After treatment, your skin will be more sensitive to the sun and may burn more easily. It is important to protect your skin from the sun. Some chemotherapy drugs and radiotherapy can increase the risk of some skin cancers. So it is important to continue protecting your skin for the rest of your life.

Your feelings during treatment

Having a stem cell transplant is probably one of the most stressful things you will ever face. It is emotionally hard, as well as physically demanding.

There may be times when you are anxious, frightened or depressed. You may ask yourself questions like:

  • ‘Is the treatment working?’
  • ‘Will my blood counts ever go up?’
  • ‘How am I going to cope with the side effects?’.

Talking to family and friends about how you are feeling often helps. The nurses and doctors can also give you advice and support. They may be able to put you in contact with someone else who has had a stem cell transplant. Many people find this very useful.

If you are finding it difficult to cope, tell your nurse or doctor. You may find it helpful to talk to someone such as a counsellor. The hospital staff can arrange this for you.

Support from Macmillan

Macmillan is here to support you. If you would like to talk, you can:

About our information

  • References

    Below is a sample of the sources used in our stem cell and bone marrow transplants information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Carreras, Dunfour, Mohty and Kröger. The European Society for Blood and Bone Marrow Transplantation: Hematopoietic stem cell transplantation and cellular therapies. Springer, Switzerland. 2019. 

    FACT-JACIE International Standards for Hematopoietic Cellular Therapy – product collection, processing and administration. 7th edition. 2018. 

    Anthony Nolan. Operations and patient services user guide. Available from www.anthonynolan.org. Accessed January 2019.


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.