Autologous Transplant (Bone Marrow & Stem Cell)

What does autologous mean?

Autologous means that the transplant cells come from the same person getting the transplant. If you are the one getting the transplant, you will receive your own cells back. You might hear this type of transplant being called an “auto” transplant for short. This is different than an allogeneic transplant, where the transplant cells come from another person who donates their cells. 

What are bone marrow and stem cells?

Bone marrow is a spongy material found inside your large bones, like your femur (thigh), hip, and ribs.

Stem cells are "blank" cells in your body that can become many different kinds of cells in your body as needed. There are a few different kinds of stem cells:

• Bone marrow is made of cells called hematopoietic stem cells.
• Stem cells found in your bloodstream are called peripheral blood stem cells.
• Stem cells used for research are called embryonic stem cells.

Hematopoietic stem cells in your bone marrow are "baby" cells that become white blood cells, red blood cells, or platelets. They are also called blood-forming stem cells. They grow and are stored in the bone marrow until they are needed. Each type of cell has a job:

• White blood cells (leukocytes) help fight infection.
• Red blood cells (erythrocytes) carry oxygen from your lungs to the rest of your body and return carbon dioxide to your lungs as waste.
• Platelets (thrombocytes) help your body form blood clots to control bleeding.

What is an autologous transplant?

An autologous transplant is used to treat some cancers. Your own healthy cells are transplanted back into your body. In the past, the stem cells were taken directly from your bone marrow by placing needles into your hip bones and drawing the stem cells out. This is why transplants are sometimes called bone marrow transplants.

Transplants are used to treat many different cancers, such as leukemias, myelodysplastic syndrome, multiple myeloma, Hodgkin's disease, non-Hodgkin’s lymphoma, testicular cancer and neuroblastoma, among others.

What happens before my transplant?

Your cells will be collected using a medication called granulocyte colony-stimulating factor, or GCSF. This medicine stimulates (revs up) your stem cells to be released from your bone marrow and into your bloodstream. A blood test is used to see how many cells are in your bloodstream. Once the number is high enough, you will go to a special area in the hospital where pheresis is done to have the cells taken out from your bloodstream. This procedure is called "apheresis.” With apheresis, there is no longer a need to remove stem cells from bone marrow. During apheresis:

• Your cells are taken out using a catheter (small, flexible tube) in your chest wall, or with 2 large intravenous (IV) catheters, one placed in each arm.
• Blood is taken out, run through the pheresis machine to remove the stem cells, and the rest of your blood is returned to you.
• The cells are frozen in a preservative called dimethyl sulfoxide (DMSO). Preserving the cells on ice, called “cryopreservation,” is needed because the cells are removed (“harvested”) months before your transplant and need to be stored.
• During the collection, you may have tingling or numbness around your lips. This is caused by a loss of calcium and often gets better by eating some calcium tablets.

In the days before your transplant, you will get high doses of chemotherapy and, in some cases, radiation. Chemotherapy is a group of medications that kill cells that quickly divide in your body. Cancer cells tend to divide quickly, but so do many healthy cells (like cells in your gastrointestinal (GI) tract, hair follicles, and blood cells). Because of this, chemotherapy can also damage your healthy cells, causing side effects. "Dose limiting toxicity" is when your side effects are so serious that your provider lowers your dose of chemotherapy. Low blood counts (low white blood cells, red blood cells, and platelets) are a side effect that can limit your dose of chemotherapy.  

With an autologous transplant, providers give you high doses of chemotherapy to wipe out your bone marrow. They later "rescue" your bone marrow using your own stem cells that have been collected and cryopreserved.

How is the transplant done?

After the high doses of chemotherapy, you will rest for 1 or 2 days to let your body process and clear out the chemotherapy, so the new cells are not damaged. The day of the transplant is sometimes called “Day 0.”

• On the day of the transplant, you are given some medications (called pre-medications) to prevent reactions to the DMSO preservative.
• You will also get intravenous (IV, into a vein) fluids.
• Your blood pressure and heart rate are closely watched. Once you have received the pre-medications, the frozen stem cells are thawed. They are given back to you like a blood transfusion. They are given through your IV line.

The stem cells go to your bone marrow space and start making new cells to replace all those that were killed ("ablated") by the chemotherapy.

What happens after the transplant?

As your new cells start working, your blood counts will stay low for a period of time. While your counts are at their lowest, it is called the “nadir.” It is often the hardest part. When blood cell counts are very low, you are at higher risk for infections, bleeding, and severe fatigue. You do not have any white blood cells to fight infections, so you may have fevers and need antibiotics. All visitors and healthcare staff must wash their hands before entering your room. Anyone who is sick or lives with someone who is sick should not visit.

Low platelet counts can cause bleeding. Platelet transfusions are common during this time. A low red blood cell count (called anemia) can also be hard. You may look pale, feel very tired, and need red blood cell transfusions. Many patients say the worst side effect is extreme fatigue. Just getting out of bed is a chore. If your nurse says it is okay, take short walks in the halls or do light exercise in your room.

You will also have side effects from the chemotherapy you had. You may have diarrhea, nausea and/or vomiting, hair loss, fever, chills, decreased appetite, and mouth sores (called mucositis). Every patient’s side effects are different, but your care team will be checking in with you often.

You may be in the hospital or at a nearby clinic during this time where your health can be closely monitored. During this time, you may want and need the support of your family. You may also not be feeling well and just want to rest. Be honest with your loved ones about how they can be helpful. Pick one person to update regularly who can then share

What is engraftment?

Engraftment happens when the stem cells start doing their job and blood cell counts start to come up (recover). It can take about 7 to 12 days after Day 0 for the stem cells to make new cells, and for those new cells to work the way they should.

• The first number your care team will look for is your neutrophil count. Neutrophils are a type of white blood cell that are most important in fighting infection. Yoiur care team will watch your neutrophil count each day. When it reaches a certain level, you can stop antibiotics and, in many cases, go home. The time until engraftment varies but is often about 7 to 12 days.
• Your red blood cell and platelet counts can take a few weeks to get back to a normal range, but you can often go home once you don’t need blood or platelet transfusions as often.

You will start to feel better as your numbers come up. Your providers will tell you what you need to do to stay as healthy as possible when you go home.

How will I feel once I am home?

This depends on what has happened over the past few weeks. It can take weeks, months, or even a year to feel like your "old self" again. Some patients report having no appetite, or food tasting like metal for months after the transplant. This can be a hard time, as family and friends may assume that you are "better" since you are home and the transplant is over. They may expect you to go back to normal life. Let others know what you need and how they can be most helpful.

If you have any questions about your autologous transplant, talk with your provider.  

Resources for More Information

Blood Forming Stem Cell Transplants from the NCI.

What is a Stem Cell Transplant from ASCO.