What is an autologous stem cell transplant?
An autologous transplant is stem cell transplant (ASCT) that uses your own stem cells, which means you are your own donor. In this type of transplant, your stem cells are harvested (removed), frozen and stored before you receive high doses of radiation therapy or chemotherapy, or both.
After you receive your high-dose cancer treatment to remove cancerous cells from your body and/or marrow, your harvested stem cells are thawed and returned back into you. This is known as a “rescue” in autologous transplant.
Autologous vs allogeneic stem cell transplant
An autologous transplant uses your own stem cells for transplantation. In contrast, an allogeneic stem cell transplant uses cells from another donor. The donor stem cells must have a genetic typing that matches yours. Usually, donors come from a direct relation (such as a sibling).
Why do you need an autologous stem cell transplant?
Autologous transplant is a type of stem cell transplant used to treat:
- Multiple myeloma and occasionally for certain rare solid cancers and uncontrolled autoimmune conditions
Your doctor may recommend an autologous stem cells transplant if your disease will benefit from one as part of your treatment.
Since you are getting your own cells, there is no risk that your immune system will reject the transplant or that the transplanted cells will attack your own body.
A disadvantage of an autologous transplant is the side effects of high dose chemotherapy such as hair loss, nausea, vomiting, diarrhoea, ulcer in the mouth and infection due to low white cells count.
The disadvantage of an autologous transplant is that cancer cells may be harvested along with the stem cells and then reinfused back into the body. To minimise risk, doctors may treat the cells first with anti-cancer drugs or other therapies to reduce the number of cancerous cells that may be present.
Who should not undergo autologous stem cell transplant?
You may be ineligible for an autologous stem cell transplant if you have other major health problems such as serious heart, lung, liver, or kidney disease.
What are the risks and complications of an autologous stem cell transplant?
Cancer cells may be harvested along with the stem cells and then reinfused back into the body. To minimise risk, your doctor may treat the cells first with anti-cancer drugs or other therapies to reduce the number of cancerous cells that may be present.
Many of the side effects of an autologous transplant result from the chemotherapy or radiation therapy given before the transplant. Others are related to the stem cell transplant.
Initial side effects can include:
- Mouth and throat pain
- Nausea and vomiting
- Bacterial, viral or fungal infections
- Bleeding and anaemia (low red blood cell count)
- Lung problems such as pneumonitis, an inflammation of lung tissue
- Side effects from conditioning chemotherapy, such as injury to heart muscles, kidney and liver
Longer-term side effects can include:
- Eye problems such as cataracts
- Organ damage
- Return of the cancer
- Secondary cancers
- Lymph tissue problems
- Thyroid problems caused by hormone changes
How do you prepare for an autologous stem cell transplant?
Autologous stem cell transplants may need extensive preparations, such as:
- Appointing a primary caregiver to look after you and update your medical team when necessary.
- Making necessary work and personal arrangements for your hospital stay.
- Preparing your home to facilitate your recovery after your hospital discharge.
- Cleaning your home, especially the rooms that you will be mostly resting in. This is important as your immune system will be weakened after the stem cell transplant, which makes you more likely to be infected by bacteria.
- Target areas that may have dust, mould, mildew, and other tiny particles which may be harmful for you during your recovery.
- Going through medical tests, such as:
- Blood tests
- Complete physical exam, including evaluation of your heart, lung and kidney function
- For young patients, discussion on sperm preservation and ovary freezing
- Evaluation of your psychological and emotional states.
- Bone marrow biopsy
- CT scan or MRI scan
- Visiting the dentist to get any dental work done in advance. Once you start your stem cell transplant, you will be at a higher risk of infection.
- Taking care of your diet and fitness. A healthy lifestyle is key for helping you prepare for your transplant. Start with small steps, such as:
- Eating little and often.
- Adding protein and calorie-rich ingredients into your meals.
- Doing gentle exercises such as walking, cycling and yoga.
What can you expect in an autologous stem cell transplant?
An autologous stem cell transplant does not involve surgery. It is a procedure in which a needle will be inserted into your vein and you are hooked up to a machine to extract and later return stem cells into your body.
The entire autologous stem cell transplant process may take up to a week.
Before the procedure
You will be given medication to help your stem cells multiply and move out of your bone marrow and into your blood stream for easier collection.
During the procedure
Below are the different stages of the autologous stem cell transplant procedure.
- Stem cell collection. A specialist will insert a needle into a vein in your arm to draw out blood. The blood will run through a machine which extracts the stem cells and returns the rest of your blood back to your body.
- Stem cell preservation. Your doctor will add a preservative to your stem cells before freezing them for later use.
- Conditioning. Conditioning therapy is used to remove any remaining cancer cells in your body and prepare your bone marrow to receive the donor stem cells. Your doctor will schedule chemotherapy or radiation therapy, or both. Your bone marrow may get damaged as a result of these treatments.
- Infusion of stem cells. To repair your damaged bone marrow, the frozen stem cells will be thawed and returned into your blood stream. The stem cells will travel to your bone marrow and create new blood cells.
- During infusion, you may experience pain, chills, fever, hives and chest pain.
After the procedure
After undergoing a stem cell transplant, you will be kept under close medical care to monitor your body's response to the procedure.
There is a possibility of a relapse of cancer after your transplant. A relapse usually occurs when not all the cancer cells were killed during chemotherapy and radiation.
A relapse can be treated with chemotherapy, a second stem cell transplant (possibly using a donor's cells), or a combination of both.
Care and recovery period for an autologous stem cell transplant
Your recovery process may take several months or longer, during which you may not be able to return to work or resume your previous lifestyle. You may also have to attend frequent follow-up appointments with your doctor to check on your health and progress.