You have high-dose chemotherapy and sometimes radiotherapy before your healthy stem cells are given back to you.
You usually stay in hospital to have the treatment. Although the treatment may only last 1 or a few days, you will probably be in hospital for a few weeks. This is because you need to wait for your blood count to recover, which can take 2 to 3 weeks.
In some hospitals, you have high-dose treatment as a day patient and stay in accommodation nearby. The hospital will arrange this for you. When your blood counts become low, you will be admitted to the hospital.
We have more information about getting ready to go into hospital.
Visitors, especially close family and friends and your partner, if you have one, are important.
Most units are flexible about visiting, but different hospitals have different rules. You may be restricted to a certain number of visitors each day to help protect you from infection. The nurses will explain more about this to you.
The chemotherapy drugs are given through your central line or PICC line with plenty of fluids. The treatment is usually given over several days. Chemotherapy can cause side effects. Your doctor and nurse will explain how these can be managed. You will be given drugs to help control certain side effects.
Radiotherapy uses high-energy rays to destroy cancer cells. TBI treats your whole body with radiotherapy and some people have it as part of their conditioning treatment. You usually have it a few days after you start chemotherapy.
You may have TBI twice a day for 6 to 8 sessions over 3 to 4 days. If you are having reduced-intensity conditioning, you may only need one or two low doses of TBI or none at all.
You will have a planning session in the radiotherapy department a few days before you have TBI. The doctor will explain more about the treatment and its side effects.
Before each session, the radiographer (person who gives the treatment) positions you carefully and makes sure you are comfortable. Radiotherapy is not painful, but you need to keep still during the treatment. You have radiotherapy to both sides of your body so you need to change position a few times during the session. The radiographer will explain this to you.
During treatment, you are alone in the room but you can talk to the radiographer through an intercom. Each session lasts about 40 minutes, but the radiotherapy itself only takes about 10 to 20 minutes. You can bring some CDs to listen to during your treatment.
Side effects of TBI
Possible side effects of TBI include skin changes, tiredness, feeling sick, diarrhoea and a sore mouth. These can happen a few days later. The radiographers will explain how to manage the side effects and how to care for your skin. We have more information about radiotherapy side effects.
After your high-dose treatment, your stem cells will be given back to you by a drip (infusion) through your central line or PICC line. This will be 1 to 2 days after the high-dose treatment has finished. This is similar to having a blood transfusion.
You will be closely monitored during the infusion. Some people have mild side effects during the infusion, such as breathlessness or feeling sick (nausea). Very rarely, a severe allergic reaction can happen. You will be given medicine before the infusion to help prevent or reduce any reaction.
You and your visitors might notice a strong smell like sweetcorn for a few days after the infusion. This is from the preservative that is used to protect the stem cells during storage.
Once you have had the infusion, the stem cells travel through your blood to your bone marrow. They then start to make new blood cells. This is called engraftment. It usually takes 10 to 12 days before some of the new blood cells are released into the bloodstream. For some people it may take longer. During this time, you are at high risk of infection and other problems, such as bleeding and anaemia.
You will have low numbers of red blood cells, white blood cells and platelets in your blood for some time. This can cause some of the main side effects. You will have blood samples taken every day to check your blood count. You may be given a drug called a growth factor as an injection. It stimulates your bone marrow to make new blood cells and reduces the length of time you are at risk of side effects.
We have more information about these side effects.
Your daily routine
Once your blood count is low, you will usually stay in a single room to help protect you from infection. Your day can be quite busy with daily routines and checks by the doctors and nurses. They may:
- take blood samples from your line
- give medicines into your line
- change your drip (infusion) of fluids when needed
- take your temperature, pulse and blood pressure
- examine your tummy and mouth
- check your central line or PICC line.
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 by yourself
- be able to take your tablets so you do not need drugs through your line.
You can usually have your central line removed when you leave 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 relative, friend or partner to stay with you for a time. Or the hospital staff can arrange support from carers when you go home. We have more information about recovering from treatment.