About Autologous Blood Stem Cell Transplantation

Overview

A blood stem cell transplant delivers healthy stem cells into the patient to replace bone marrow that is either not working properly or has been destroyed by chemotherapy or radiation therapy. Stem cell transplants are similar to blood transfusions and generally do not require surgery.

Scott & White patients with cancer of the plasma cells in their bone marrow (multiple myeloma) and cancerous cells in their lymph system (lymphomas) are treated with high-dose chemotherapy. This treatment is very effective at destroying cancer cells, but it also destroys the patient’s healthy bone marrow cells.

To rescue the bone marrow and effectively improve the patient’s condition, the transplant team performs an autologous blood stem cell transplant in which the patient gets back his own healthy cells, which were collected before chemotherapy. Released back into the patient’s blood stream, the collected stem cells migrate to the bone marrow to restore its function and start making new blood cells.

Stem Cell Collection and Transplant Process

Collected cells are adult stem cells that are destined to become blood lines. These blood lines contain white cells that fight off infection, red cells that provide oxygen to the blood, and platelets that release a chemical to help the blood clot.

How We Collect Stem Cells

Cells are collected through a process called stem cell mobilization. Before the mobilization can begin, an intravenous line, also called a central line, is placed in the patient’s chest. The process then begins by injecting a drug that stimulates the stem cells to leave the patient's bone marrow and enter into the blood stream where they can be extracted. A machine, called an apheresis machine, collects the blood that contains these cells.

This process can take up to about four and a half hours and may have to be repeated several times to acquire the necessary number of stem cells.

After Stem Cells are Collected

At the end of the collection process, the processing lab obtains the number of useable stem cells. The doctor can then determine if additional stem cells are needed. It could take several collection days to acquire enough stem cells to perform the stem cell rescue once the patient has completed Chemotherapy. The high-dose chemotherapy treatment begins approximately two weeks after stem cell collection.

How are the stem cells stored? If enough cells have been collected, the specimen is treated with a cryopreservative called dimethyl sulfoxide (DMSO) that freezes the cells until they can be given back to the patient. This chemical helps to keep the cells from bursting under the pressure of freezing.

The cells are stored in a freezer in nitrogen between -150 and -160 degrees Fahrenheit. The cells are stored at the Scott & White facility for five years if not used. At the end of five years, the patient can opt to continue storing their cells or have them disposed of.

Unfortunately, the DMSO chemical can also cause some side effects when the treated cells are given back to the patient. The most common side effects are increased blood pressure, coughing or nausea and are mostly mild.

Stem Cell Rescue (Transplant)

Approximately two weeks after blood stem cells are collected, the patient returns to the transplant facility for high-dose chemotherapy treatment. After this treatment, the patient's stem cells are thawed and transferred back into their body through a central line.

What are the side effects of this procedure? The patient emits a cream corn-type odor for a couple of days after the procedure. Patients are instructed to bring hard candies to combat the taste.

Preparing for Your Blood Stem Cell Transplant Surgery

As the transplant recipient, you and your family should be constantly educating yourselves. Scott & White provides pamphlets and videos to patients, and encourages you to ask questions.

To help prepare you for the stem cell rescue, transplant coordinators will instruct you and your family about what will happen during each step of the process, including the mobilizing medications that you might need to administer at home. A transplant coordinator is available to show you how to inject yourself with the mobilizing medicine.

What to Expect After Your Blood Stem Cell Transplant Surgery

Recovery

Hospitalization can last just two weeks to more than a month, depending on if there are any post-transplant complications. In the first two weeks after the procedure, your immune system will be compromised and a transfusions of red blood cells and platelets may be needed. While these cells are being added back into your body, the injected stem cells are beginning to make new blood cells. We will monitor you closely to make sure the bone marrow and immune system are functioning correctly.

Your Responsibilities After Surgery

As the patient, you're going to have to watch for infection, control your diet and add activity back into your lifestyle.

How We Support You After Surgery

Scott & White offers you services to help with the transition from hospitalization to post-transplant life, including:

Social work support, including visits with counselors.

Financial assistance programs

Close monitoring by medical staff through supportive care with fluids and blood work

Is This Procedure a Cure for Lymphomas and Multiple Myeloma?

For lymphoma, the stem cell rescue can be a cure, but for multiple myeloma the procedure can only prolong life.

What is the National Major Donor Program?

The National Marrow Donor Program (NMDP) was started in 1986 to serve as a national database of tissue types from individuals willing to donate marrow to patients needing a marrow transplant. Since that time, the registry, now called the Be The Match® Registry, has over 8 million individuals registered. It is linked with registries all over the world, making it an international registry to serve any patient needing a transplant anywhere in the world.