Autologous stem cell transplants: What to expect

Since they were first introduced more than 60 years ago, stem cell transplants have cured or extended the lives of millions diagnosed with aggressive lymphomas, leukemias, myelomas and other blood cancers.

One type of transplant, called an allogeneic transplant, uses stem cells from a donor. But in many cases, a transplant may use stem cells from a patient’s own body. This is called an autologous stem cell transplant.

We talked with Partow Kebriaei, M.D., to learn more about what happens when a patient becomes their own donor.

What are hematopoietic stem cells?

The immature, undeveloped cells that live in the bone marrow where blood is made are called hematopoietic stem cells. Hematopoietic means blood-forming. These “baby” cells have not yet decided which type of blood cell they want to be when they grow up. Eventually, they’ll mature into one of three types:

• white blood cells to fight infection
• red blood cells to carry oxygen throughout the body
• platelets to control bleeding

Who needs a stem cell transplant, and why?

Patients with blood cancers receive high doses of chemotherapy to wipe out cancer cells in the bone marrow. The powerful treatment kills not only cancer cells, but also healthy, blood-forming stem cells. These hematopoietic stem cells need replacing after the chemotherapy ends so the body can continue making blood.

What is an autologous stem cell transplant?

Some patients rely on healthy donors for stem cells. Others “bank” their own stem cells, which will be transplanted back into their bone marrow after the high-dose chemotherapy treatment is complete. This type of transplant is called autologous. Auto means self.

Who is eligible for an autologous stem cell transplant?

Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. This type of transplant is used most frequently to treat multiple myeloma and lymphoma.

Leukemia patients usually receive an allogeneic stem cell transplant.  That’s because research has shown that stem cells from donors help prevent leukemia from returning.

What are the steps in an autologous stem cell transplant?

1. Collecting the stem cells: Before treatment begins, a needle is inserted into the patient’s arm vein. Blood is withdrawn and redirected into a special machine that removes about 4 million stem cells – the amount needed for a transplant. The stem cells are frozen until needed, and the rest of the blood is returned to the patient’s body. 
   
   
2. Conditioning: The patient receives high doses of chemotherapy to kill cancer cells and prepare, or “condition,” the body for transplant. This typically takes one to seven days.
   
   
3. Transplanting the stem cells: After conditioning is completed, the stem cells are thawed and reintroduced into the recipient’s vein through an IV. The stem cells automatically migrate to the bone marrow. About two weeks later, they begin producing normal, cancer-free blood cells.

What happens after an autologous stem cell transplant?

Many transplant recipients agree that the several weeks following transplant are the most challenging. Their blood counts are still very low during this time. Infection risk is high due to lack of infection-fighting white blood cells. Patients may be anemic due to lack of red blood cells. They’re also at risk for bleeding due to lack of platelets.

Doctors prescribe antibiotics to prevent infections, and patients will likely need transfusions of platelets and red blood cells. During this time, they’ll still be experiencing side effects of the chemotherapy they received during conditioning. Side effects may include nausea, diarrhea, hair loss, mouth sores and fatigue.

Most autologous transplant patients see a steady return to normal blood counts within two to four weeks. They can usually return to their normal activities in three to six months.

What’s the difference between a stem cell transplant and a bone marrow transplant?

In the early days, stem cells were collected directly from the bone marrow. Patients were taken to the operating room, anesthetized, and doctors inserted needles to remove bone marrow from the hip bone. Stem cells were extracted from the marrow and frozen until transplant day. This is where the term “bone marrow transplant” originated.

Today, we use medications that stimulate the stem cells to move out of the bone marrow and into the bloodstream, where they can be collected more easily. Stem cell transplant is very similar to bone marrow transplant, except the stem cells are harvested from the patient’s bloodstream rather than from the bone marrow.

What’s the main advantage of an autologous stem cell transplant?

A successful autologous stem cell transplant helps many people with lymphoma or multiple myeloma become cancer-free or delays the cancer’s return. Patients who use their own cells avoid graft vs. host disease, which occurs when the body views cells from a donor as foreign and attacks them.

Is one autologous stem cell transplant enough?

Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant.

What’s your advice for patients considering an autologous stem cell transplant?

Recovery is a slow process, so patience is required. Most patients go from feeling lousy the first month after transplant to feeling back to normal six months later.

But everybody’s different. Some patients recover in three months, and some need a year to regain their strength and stamina. Take one day at a time, and you’ll get through it. Your MD Anderson team is here to support you every step of the way.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.