An autologous transplant uses stem cells collected from the person receiving transplant.
Types of Stem Cell Collection
There are two methods of collection: peripheral blood stem cell (PBSC) and bone marrow. The patient's doctor chooses the donation method that is best for the patient.
- PBSC donation: This procedure is non-surgical. They are either collected in the outpatient BMT clinic or inpatient BMT unit.
- Bone marrow donation: This is a surgical procedure and must take place at a hospital.
- The patient receives anesthesia so no pain is experienced.
- The physician collects the stem cells from the patient's bone marrow through a needle.
- The liquid bone marrow is drawn through the needle from the pelvic bone.
The Transplant Process
The first step in a PBSC collection is priming, or mobilization. Priming stimulates the bone marrow to release stem cells into the bloodstream. Priming may be done with chemotherapy followed by Neupogen or Neulasta. Your physician will decide what is best for you and your treatment plan. Once you begin Neupogen therapy, we will do daily blood tests to see when the best time will be to collect the cells.
Once stem cells have entered the blood stream, we use a process called apheresis to collect them. This procedure is similar to plasma donation.
We will place two peripheral IVs, a central line, or a temporary apheresis catheter into a vein to collect the blood. You will be hooked up to the apheresis machine for approximately 4 hours a day (the number of collection days varies per person). The machine will collect blood from one IV line, place it in a centrifuge and collect the stem cells, and then return the rest of the blood to you through the second IV line.
The anticoagulant used during apheresis to prevent the blood from clotting can sometimes bind with the calcium in your blood, making you feel like you have symptoms of low calcium: lightheadedness and numbness or tingling in the lips, hands, or toes. Make sure you tell your nurse if you should experience any of these symptoms. The nurse can quickly give you calcium through your IV to reverse the effect.
Preparative Transplant Regimen
Depending on your transplant regimen, you will receive high doses of chemotherapy and/or Total Body Irradiation (TBI). These will destroy your disease and prepare your marrow for new stem cells. Unfortunately, these two therapies not only destroy the cancerous cells, they will also harm other healthy cells in you bone marrow.
After your chemotherapy, the bone marrow or stem cells will be infused.
The day of infusion of stem cells is referred to as Day 0. You will hear all days prior to your transplant referred to as negative days. For example, you may receive chemotherapy on Day -4 through Day -1. All days post-transplant are considered positive. For example, you may expect to engraft on Day +10.
The infusion of stem cells will be much like a blood transfusion. The stem cell technician will thaw your frozen stem cells, and your nurse will administer them.
The new stem cells will migrate from the bloodstream to the bone marrow spaces. From here, the transplanted stem cells will begin to create new cells. This process is called engraftment. We will do lab tests on your blood often to see if you have engrafted.
Your immune system will be very weak at this point. Expect to be placed on several preventive medications during this period, such as antibiotics, antivirals, and antifungals. Your nurse will check your temperature often for fever, as fever is a sign of infection.
In the days after transplant, patients usually experience side effects from chemotherapy:
- Mouth sores
You will receive instruction and education on ways to prevent some of these side effects, as well as ways to help minimize them.
Engraftment means that the stem cells have started producing their own white blood cells, red blood cells, and platelets. After your transplant, we continually do tests to see how many neutrophils, a type of white blood cell, are in your blood. This test is called an absolute neutrophil count (ANC). When your ANC is more than 500 for three consecutive days, engraftment has occurred.
Engraftment date varies from person to person and depends on the kind of transplant that you had. Once you have engrafted, your health care team will start taking away some of your preventive medications.
If you have been staying in the hospital, you will be discharged when your health care team determines you are well enough. You will still be in recovery, however. You are still at risk of infection, and you will need a caregiver to help you at home 24 hours every day for at least two weeks after your transplant.
You may need to visit the hospital again during this time. Many patients struggle with infections, nausea, or diarrhea after discharge. The BMT outpatient clinic and a home health care agency will provide additional IV medications, blood transfusions, and fluids as indicated after discharge.
100 Days after Transplant
We will do lab tests 100 days after transplant. This is called your day +100 workup. This workup will tell us whether you can return home if you have been temporarily staying in the Salt Lake area.
Once BMT physicians have determined that you are stable, you may return to your local or referring oncologist for care.
You will no longer be required to have a 24-hour caregiver, but you are still at risk of infection. Good hand washing and wearing your BMT mask in crowds is required.
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