Autologous Haematopoietic Stem Cell Transplant
autologous stem cell transplant, autologous bone marrow transplant, aHSCT
Autologous haematopoietic stem cell transplant is a medical procedure that uses your own healthy blood stem cells to restore your body’s ability to make blood cells after intensive cancer treatment.
Table of contents
- What is an Autologous Haematopoietic Stem Cell Transplant?
- Conditions Treated with This Procedure
- How the Procedure Works
- Preparing for the Transplant
- The Transplant Process
- Recovery and Long-term Outlook
- Preventing Infections After Transplant
What is an Autologous Haematopoietic Stem Cell Transplant?
An autologous haematopoietic stem cell transplant uses healthy blood stem cells from your own body to replace bone marrow (the soft, spongy tissue inside bones that makes blood cells) that is not working properly.[1] This procedure is also called an autologous bone marrow transplant.[1]
The main advantage of using your own cells is that you do not need to worry about whether the cells will be compatible with your body. There is no risk of your body rejecting the cells because they come from you.[1] This is different from a transplant where cells come from another person, called a donor.
An autologous stem cell transplant might be an option if your body is producing enough healthy bone marrow cells that can be collected, frozen, and stored for later use.[1] The procedure works by allowing doctors to give you very high doses of treatment to kill cancer cells, while your stored healthy cells protect you from the harmful effects of that treatment.[5]
Conditions Treated with This Procedure
Healthcare providers most commonly use autologous stem cell transplantation as the initial treatment for multiple myeloma, a condition where cancerous cells in your bone marrow multiply and make abnormal proteins.[5] More than half of autologous transplants are performed for multiple myeloma and non-Hodgkin lymphoma (a type of cancer that affects the body’s infection-fighting system).[6]
This procedure may be used to treat Hodgkin lymphoma and non-Hodgkin lymphoma if other treatments are not effective or if the cancer comes back after treatment.[5] Autologous transplants can also be used for treatment-resistant germ cell tumors (cancers that develop from reproductive cells) and some autoimmune diseases when other treatments have not worked.[5]
Autologous haematopoietic stem cell transplantation is commonly used for the treatment of blood cancers and has increasingly been used since the late 1990s for severe autoimmune diseases that do not respond to conventional treatments.[2] The list of diseases for which this procedure is being used is rapidly increasing and currently numbers more than 70.[6]
The procedure may be an option when other treatments are not effective, or when cancer comes back. Research shows it may put certain blood cancers into long-term remission, meaning you do not have symptoms and tests do not find signs of cancer.[5] However, this procedure may not cure cancer in all cases.[5]
How the Procedure Works
In an autologous stem cell transplant, your healthcare team removes healthy blood stem cells from your body before you receive high doses of chemotherapy (powerful drugs that kill cancer cells) to kill cancerous cells. You may also receive radiation therapy (treatment using high-energy rays).[5]
The same treatment that gets rid of cancerous cells also kills healthy cells. It can also damage your bone marrow so it stops making blood cells.[5] An autologous stem cell transplant is how you receive healthy blood stem cells so your bone marrow can make new, healthy blood cells.[5]
The procedure involves the intravenous infusion of blood stem cells to reestablish blood cell production in patients whose bone marrow or immune system is damaged or defective.[6] Worldwide, approximately 90,000 first transplants are performed every year, with 53% being autologous transplants. The number continues to increase by 10 to 20% annually.[6]
Preparing for the Transplant
The first step before an autologous stem cell transplant is to check on your overall health apart from your blood cancer. High-dose chemotherapy can cause significant side effects and increases your risk of serious infections.[5]
Your healthcare provider will order several tests, including an electrocardiogram (a test that checks your heart’s electrical activity), echocardiogram (an ultrasound of your heart), CT scan (a detailed imaging test), complete blood count (a test that measures different components of your blood), and blood tests to check liver and kidney function.[5] Your provider may also take a biopsy (a small sample of tissue) to study cancerous cells.[5]
Before your blood tests, your provider may place a central venous catheter, which is a thin tube inserted into one of the large veins in your upper chest. Having this tube in place means you can avoid repeated needle sticks to draw blood or to insert intravenous tubes throughout the transplant process.[5]
Once you are cleared for transplant, you will receive growth factor drugs, which are hormone-like substances that help your bone marrow make more blood cells. You will also receive other drugs that help move your blood cells from your bone marrow into your bloodstream. Your provider may call this process “mobilization.”[5]
The Transplant Process
The transplant process generally is divided into five phases: conditioning, stem cell infusion, the period when white blood cell counts are very low (called the neutropenic phase), the period when new cells start growing (called the engraftment phase), and the period after engraftment.[6]
Collecting Your Stem Cells
In stem cell collection, providers take blood from you so they can remove healthy blood stem cells for transplant. This process is called apheresis.[5] Providers connect veins in both of your arms to a cell separator machine. The machine pulls blood from the veins in one arm, flows it into the cell separator machine which filters out stem cells, and then the blood flows back into veins in your other arm.[5]
The harvesting process does not hurt but can take three to four hours. Your providers may need to take blood more than once to be sure they have enough stem cells.[5] After collection, your stem cells are frozen and stored for later use.[1]
Conditioning
The conditioning period typically lasts 7 to 14 days. The purpose is to deliver chemotherapy, immunotherapy, or radiation to eliminate cancer, prevent rejection of new stem cells, and create space for the new cells.[6] Myeloablative regimens are designed to kill all residual cancer cells and may contain radiation or not contain radiation. Nonmyeloablative regimens are less intensive and cause less damage to the bone marrow.[6]
Transplantation
After the conditioning treatment, you receive your stored stem cells back through an intravenous infusion, similar to receiving a blood transfusion. The stem cells find their way back to your bone marrow. Your body then starts making blood cells again and your bone marrow slowly recovers.[5]
Recovery and Long-term Outlook
It takes a long time to get over intensive treatment such as a stem cell transplant. It may be several months before you really feel you have got your strength back.[20] Feeling extremely tired is normal to begin with and affects some people more than others.[20]
You will need regular follow-up appointments after your transplant. These may be weekly to begin with and gradually become less frequent. These appointments are to keep an eye on your general recovery, check your blood cell levels, and find out how well the treatment has worked.[20]
You might still need to have blood or platelet transfusions after you go home. During the first few months you are at risk of having a reaction to blood transfusions. To prevent this, any blood or platelets you have must be irradiated, which means they have been treated with radiation. This destroys any white cells that could cause a reaction.[20]
Your nurse will give you a card to carry with you that tells doctors that any blood you need in an emergency should be irradiated. Your doctor or nurse will tell you how long you need to carry this card, usually for about a year.[20]
It might be as long as a year before you really feel you are on the road to recovery.[20] When you get home, you can contact your healthcare team with any worries or questions. You will start to feel stronger and more active again as time passes.[20]
Preventing Infections After Transplant
After a transplant, it takes time for your blood cell levels to recover and for your immune system to work properly again. During this recovery period you are at higher risk of infections.[20] It is likely that you will get at least one infection after your transplant, and you might need to stay in hospital again.[20]
You will need to take medicines to prevent infections for the time you are in hospital and for the first few weeks at home.[20] Your doctor and nurse will talk to you about what you can do to lower your risk of getting an infection.[20]
Precautions at Home
You should limit the number of visitors to your home to reduce your risk for infection. Avoid close contact with anyone who is not feeling well or who has a respiratory illness.[16] These guidelines typically apply for 100 days after your stem cell infusion unless directed otherwise by your care team.[16]
You should not do home cleaning yourself, since it may expose you to germs or fungus. Your caregiver should help with the cleaning tasks or help find someone who can provide support.[16] The bathroom, including the shower stall, bathtub, toilet, and sink, should be cleaned each day for the first month after your transplant to prevent the growth of bacteria, fungi, and viruses.[16]
Remove plants, both live and fake, from the rooms you will be using. Do not handle or re-pot any plants in the house.[16] You should not be in a room when it is being cleaned and should wait at least 30 minutes before entering a room that has just been cleaned to allow dust and strong smells to settle.[16]
Do not go into areas that are likely to be damp, like the cellar, attic, or garage, which have increased mold, fungus, or bacteria.[16] Avoid contact with all chemicals, including paints, aerosols, cleaning fluids, paint thinners, strippers, and solvents, as they can cause nausea and trouble breathing.[16]
