What is involved in high-dose treatment with stem cell support?

Before you have a stem cell transplant, you are given high-dose treatment to try to destroy any remaining cancer cells. This is called conditioning treatment.

You usually have this treatment in hospital. Although the treatment may only last one or a few days, you will probably be in hospital until your blood count recovers. This can take two to three weeks.

You will be given advice about what to bring to make your stay more comfortable.

A combination of chemotherapy drugs will be given to you through your central line or PICC line. Some people also have radiotherapy to the whole body (total body irradiation).

One or two days after you finish high-dose treatment, a nurse will give you your collected stem cells through your central or PICC line. You will be closely monitored during the infusion.

Once you have had the infusion, the stem cells travel through your blood to your bone marrow. They then begin to make new blood. You will have a daily routine of care and checks until your blood count begins to rise.

High-dose treatment

High-dose treatment (also called conditioning treatment), is given to destroy as many cancer cells as possible that remain in your body. The treatment involves high doses of chemotherapy. Some people also have radiotherapy to the whole body. This is called total body irradiation (TBI).


Going into hospital

You usually stay in hospital to have the treatment. Although the treatment may only last one 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 two to three 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.

What to take

The nurses will suggest what to take to keep you busy and make you more comfortable. You could take a laptop, radio, MP3 player, audiobooks or relaxation CDs, books and magazines. You may also be able to take films, computer games, games or a hobby, such as knitting. Many hospitals have TVs and DVD players, and some have internet access.

You can take personal things, such as photos, pictures and maybe a clean blanket or pillow.

Take some comfortable, loose-fitting clothes. Soft, cotton materials are best, and tops with buttons will make it easier when you are being examined. An eye mask and ear plugs to help you sleep can also be useful. Ask the nurses for advice about the toiletries you should bring with you.

Visitors

Visitors, especially close family, friends and your partner, if you have one, are important. They give you support and help you keep in touch with life outside hospital. Some units have rooms for family members to stay overnight if they have a long way to travel.

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.


Questions you might want to ask

  • How many visitors can I have and how long can they stay?
  • Is there anyone who shouldn’t visit, such as children?
  • What precautions will visitors have to take when they come to see me?
  • Can I bring my mobile phone? Is there a phone I can use, and will I need coins or a phone card?
  • Can I bring a laptop or tablet, and will I have access to the internet?
  • Do I need to follow a special diet? Are there any foods that I should avoid?


Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. You will probably have had chemotherapy as part of your original treatment so you may have an idea of what to expect. 

Chemotherapy is usually given into a vein through your central line or PICC line, along with plenty of fluids. Some people may have some of their chemotherapy drugs as tablets. You usually have a combination of chemotherapy drugs

The treatment is given over one day or several days depending on the type of cancer or leukaemia you have. We have more information about chemotherapy and its side effects.


Total body irradiation (TBI)

Radiotherapy uses high-energy rays to destroy cancer cells. TBI treats your whole body with radiotherapy. Some people have it as part of their high-dose treatment. You usually have it a few days after you start chemotherapy.

You may have TBI twice a day for six to eight sessions over three to four days.

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

Possible side effects of TBI include:

  • skin changes
  • tiredness
  • feeling sick
  • diarrhoea
  • 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 general information about radiotherapy.


Having your stem cell infusion

Your stem cells will be given back to you by a drip (infusion) through your central line or PICC line. This will be one to two 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.


Waiting for your blood count to recover

Once you have had the infusion, the stem cells travel through your blood to your bone marrow. They then begin 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. We have more information about these side effects.

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.

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 due to a daily routine of care and checks by the doctors and nurses. This may include:

  • taking blood samples from your line
  • giving medicines into your line
  • changing your drip (infusion) of fluids when needed
  • taking your temperature, pulse and blood pressure
  • examining your tummy and mouth
  • checking your central line or PICC line.

Once the number of blood cells (your blood count) begins to rise, your medical team will start to plan for you to go home.

Back to Being treated with high-dose treatment with stem cell support

Collecting stem cells

Your stems cells will be collected and stored before you have high-dose treatment.