Autologous stem cell transplant is a procedure where a patient's own healthy bone marrow stem cells are collected before high-dose chemotherapy and then given back after the treatment. This way, the healthy stem cells are not damaged by the high-dose chemotherapy.
After chemotherapy, patients go through a period where they are more likely to get infections and bleeding. Giving a patient back his or her unharmed stem cells significantly reduces the length of this period to about one week. The stem cells help the body rebuild the blood and immune system more quickly. Without the transplant, it would take six to eight weeks for the person's blood counts to return to normal levels.
Most autologous transplants can be done safely on an outpatient basis with careful monitoring.
What are the steps in an autologous stem cell transplant?
The first step is to collect the bone marrow stem cells. In the past, this was done by going into the bone marrow to get the stem cells. Today we use a method called mobilization. With mobilization, the patient receives some chemotherapy combined with growth factors. This tricks the stem cells into leaving the bone marrow and going into the peripheral blood, where they can be collected more easily.
The stem cells are collected using an intravenous line, or central line, that is inserted into the chest. Blood is withdrawn and circulated through an apheresis machine, which is a device that separates white blood cells from the rest of the blood. The white blood cells contain the stem cells.
White blood cells make up less than 1% of our blood. When the white cells are collected, the rest of the blood (the other 99%) is returned to the patient through the machine. The stem cells are frozen until it is time to give them back to the patient.
Next, the patient receives chemotherapy to fight the myeloma. The chemotherapy contains anti-cancer drugs like thalidomide, dexamethasone, bortezomib, and melphalan. These chemotherapy drugs will have certain side effects, so the patient may get other medications to fight the side effects.
The next step is to give back some of the healthy stem to the patient. Some of the cells are thawed and given back, or infused, through the central line in the chest. The rest of the stem cells will stay frozen and be stored for use during the second transplant. When the stem cells are infused, they move from the blood back to the bone marrow.
The infused cells now have the important job of rebuilding the blood and immune system. The patient is monitored to see if engraftment occurs. Engraftment is when the body starts to reproduce the white blood cells and platelets and can once again fight infection. Engraftment usually occurs 12 to 15 days after the stem cells have been given back.
We ask patients to stay in the Salt Lake City area for about three weeks during their transplant. The transplant is usually done on an outpatient basis, and patients don't need to spend the night at the hospital. However, patients will need to return to the hospital frequently for monitoring.
Tandem Autologous Transplant
A tandem autologous transplant means that two autologous transplants are done within six months. This is also known as a double autologous transplant. Studies have shown improved response and survival rates with tandem transplants compared to a single transplant. Patients usually live longer and have a better quality of life.
The period of time between the first transplant and second transplant is about two and a half to three months. Data show that with autologous transplants, half of myeloma patients will survive more than ten years after the start of treatment. For myeloma patients who receive conventional chemotherapy, the median survival rate is two and a half to three years, with only five percent of patients living ten years or more.
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