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 cancer or leukaemia.

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, you have some of your stem cells taken and stored before having 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.

Reasons for having an autologous stem cell transplant

A stem cell transplant is used to treat different cancers and some types of leukaemias and lymphomas. It can help keep certain cancers, such as myeloma, in remission for longer.

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.

Making your decision

You will 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 will probably need some time to talk about it with family and close friends. Most stem cell transplant units also have a specialist nurse, a transplant coordinator, a social worker or a counsellor who you can talk to.

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. Here are some things you might want to think about:

  • Risks of stem cell transplant

    A stem cell transplant is a complex and specialised treatment. The main risks are serious infections and bleeding. These are most likely to happen when your blood counts are low. Your doctor will take into account your age and general health before advising you whether to have this treatment. Guidelines do not recommend an upper age limit for this treatment, but the risks of severe side effects increase with age. Things to take into account include:

    • your general health
    • the risk of side effects
    • the risk of the cancer coming back.
  • Fertility

    Unfortunately, most people who have high-dose treatment are no longer able to have children afterwards. Some people who have high-dose chemotherapy without radiotherapy may still be able to have children. If you are worried about this, it is important to talk to your specialist before your treatment starts. They can refer you to a fertility specialist to discuss possible options to preserve your fertility. We have more information about fertility for men and fertility for women.

  • 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. We have more information about research trials.

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 worse when your blood count is at its lowest. This is usually after the end of the first week and during the second week after high-dose treatment. When your blood count goes up, the side effects will start to improve.

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.

You may feel impatient to go home but anxious about leaving the support of the hospital. It can take time to adjust after spending so long in hospital. If you live on your own, you will need to arrange for a family member, friend or partner to stay with you. Or the hospital staff can arrange support from carers when you go home.

Because there are still some things you cannot do, it may seem as though you will never get back to normal life again. As you recover, you will find that things gradually shift away from the treatment and back to daily life.

Follow-up

After you go home you will still need to go back to the hospital outpatient clinic for regular checks. Even after your bone marrow has recovered and your neutrophils are back to a normal level, your immunity will be low for a few months.

Sometimes you may still need blood transfusions or platelet transfusions. These can usually be given as a day patient. You may have to take regular doses of antibiotics and anti-viral drugs to reduce the risk of infection.

When to contact the hospital

Always carry the 24-hour hospital telephone number you have been given. If you are worried about anything, contact them on that 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, 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.

If you become unwell, you may need to go back into hospital. It is quite common for this to happen once or twice after high-dose treatment. Although this can be worrying for you, it is not a major setback.

If you feel unwell and are unable to contact the hospital, ask someone to take you to the nearest hospital accident and emergency department immediately

Recovering from an autologous stem cell transplant

Some treatment side effects may become permanent and others may develop years after treatment has finished. There are things you can do that may help reduce the risk of late effects, or to help manage them. Your doctor will explain the possible late effects of your treatment and how you can look after your long-term health.

We have more information about recovering from an autologous stem cell transplant.

Having an autologous stem cell transplant

Having an autologous stem cell transplant is an intensive procedure. But it is less complicated than using stem cells from a donor (called allogeneic transplants). There are fewer problems and recovery is faster. You have it in a cancer unit that specialises in this treatment. You will usually need to stay in hospital for a few weeks.

An autologous stem cell transplant is done in stages.

Stage 1: Preparing for an autologous stem cell transplant

Your specialist will explain the benefits and risks of having this treatment. If you decide to go ahead, you have several courses of standard chemotherapy to get rid of as many cancer cells as possible. When you have finished standard chemotherapy, you will have tests to check your general health. You may also have tests on your heart, lungs and kidneys. We have more information about preparing for treatment.

Stage 2: Collecting 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: Having conditioning treatment

You are given high-dose treatment to destroy as many cancer cells as possible that may be left in your body. It can take from 1 day to a week. 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.

Stage 4 Having the transplant

After your high-dose treatment, your own stem cells are given back to you through a drip (infusion).

Stage 5: Waiting for your 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 number of blood cells return to a safe level. We have more information about having an autologous stem cell transplant.

Stage 6: Recovering after your transplant

When the number of blood cells in your blood has recovered and you are well enough, you can go home. Your doctor or nurse will give you advice about any precautions you need to take in the first few months, for example in your diet or lifestyle. We have more information about recovering after an autologous stem cell transplant.

We have more information about having an autologous stem cell transplant.

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