By Sherry Christiansen
Medically reviewed by Gagandeep Brar, MD
An autologous stem cell transplant (ASCT) is one that uses healthy hemopoietic stem cells (those that form the blood cells) from a person’s own body—instead of taking stem cells from a donor—to replace diseased bone marrow or bone marrow damaged by cancer treatment. Another method of autologous stem cell transplant is an autologous bone marrow transplant.
Eric Kitayama / Getty Images
The stem cells may be harvested either from the blood, using an apheresis procedure, or from the bone marrow, being aspirated using a long needle. The healthy stem cells (from the blood or bone marrow) are frozen and stored to be transplanted via infusion after cancer treatment.
The primary advantage of having an autologous stem cell transplant is to avoid severe side effects from incompatibility as might happen with a donor transplant procedure. But a person must produce enough healthy bone marrow cells before an autologous stem cell transplant can be considered.
Reasons for an Autologous Stem Cell Transplant
An autologous stem cell transplant replaces damaged bone marrow after chemotherapy or radiation is given to destroy cancer cells. A side effect of these treatments are that they destroy healthy cells as well. An autologous stem cell transplant replenishes the body with the vital new blood cells needed for life.
An autologous stem cell transplant is often used to treat specific types of cancer, such as various types of blood cancer, including:
Lymphomas (such as Hodgkin and non-Hodgin lymphoma)
Leukemias
Plasma cell disorders (involves a specific type of blood cell that begins multiplying excessively)
Multiple myeloma (a type of blood cancer that originates in the bone marrow)
Other conditions that may require an autologous stem cell transplant include:
Testicular cancer
Neuroblastoma (a type of cancer that starts in the nervous system or the adrenal glands)
Various types of cancer in children
Conditions such as aplastic anemia and autoimmune diseases, (including multiple sclerosis) as well as hemoglobin disorders such as sickle cell anemia
Perhaps the most important advantage of stem cell transplants to treat cancer is that doctors can administer very high doses of chemotherapy (drugs that kill cancer cells) which would otherwise be too dangerous. When chemotherapy or radiation is given in very high dosages, the bone marrow is damaged, and a person is not able to make enough healthy blood cells.
Who Is Not a Good Candidate?
There is no specific age limit for a person in need of an autologous stem cell transplant; but in general, HDT (high dose therapy) and ASCT (autologous stem cell therapy) are recommended for those who are under age 65. This is because most of the clinical research has been done in the under 65 age group.1 However, there are exceptions to this general guideline.
One study found that in select patients (such as elderly people with multiple myeloma) ASCT is a viable option. The study authors report that the average age of a person who is diagnosed with multiple myeloma is 72 years old, therefore, older adults—over age 65—should NOT be excluded as candidates for autologous stem cell transplantation.1
An autologous stem cell transplant is not recommended for those who have uncontrolled comorbidities, which is the presence of more than one chronic (long-term) disease at the same time.1 An example of a common comorbidity is when a person has diabetes and high blood pressure.
Studies, such as those conducted by the observational Polish myeloma study group, have shown that people with kidney impairment are more likely to experience toxicity and other complications (such as infections and inflammation of the mucous membranes) from chemo. Kidney impairment is not necessarily considered an automatic contraindication for having an ASCT; but it may indicate that a lower dose of chemotherapy is required.1
Types of Autologous Stem Cell Transplant Procedures
There are two methods for harvesting stem cells, either from the peripheral blood or from the bone marrow. The treatment goal of an autologous stem cell transplant and an autologous bone marrow transplant is the same—to replace the loss of healthy blood cells with new, transplanted stem cells. These new stem cells will give rise to each type of blood cell in the body, including white blood cells, platelets (clotting cells) and red blood cells. The difference between the two procedures is basically how the stem cells are harvested.
In an autologous peripheral blood stem cell transplant, the healthy stem cells are taken from the blood in a process called apheresis.
An autologous bone marrow transplant involves taking stem cells directly from the bone marrow via a procedure called a bone marrow aspiration. A bone marrow aspiration involves inserting a long needle directly into the spongy tissue of the bone marrow, located in the middle of some bones.
Bone marrow harvesting is done less often than peripheral blood stem cell harvesting. It is sometimes the preferred method because there is a much higher concentration of stem cells in the bone marrow (as compared to the number of stem cells circulating in the blood).
One variation of an autologous stem cell transplant procedure is called the double autologous or tandem transplant. This involves having two stem cell transplant procedures back to back—within a six-month time span—after each round of chemotherapy. The healthy stem cells are collected before the initial high dose of chemotherapy or radiation is given. The healthy stem cells are reserved, then given after each course of chemo. Tandem autologous stem cell transplants are commonly indicated in cases where a person has multiple myeloma, or in advanced testicular cancer.
It’s important to note that not all medical experts agree on the benefits of giving two stem cell transplant procedures (as compared to just one).2 Tandem transplant outcomes are still being studied.
Before the Procedure
The screening process before an autologous stem cell transplant may include:
A medical and surgical history
A physical exam
Blood tests
Chest X-ray and other types of scans
Tests to evaluate organ (heart, kidney, lung, and liver) function
Examination of bone marrow (biopsy, removing a small piece of marrow to ensure it is functioning)
Discussion with the transplant team to determine the best plan of action
Steps that a person who is getting an autologous stem cell transplant may take to get ready for the procedure include:
Learn about the procedure
Select a caregiver (friend or family member to provide support and care after the procedure)
Meet with each member of the transplant team (such as cancer, blood, and other specialists, the social worker, dietician, educational nurse and more)
Arrange for a leave of absence from work
Plan where you will reside after the procedure (transplant recipients must live within an hour of the facility for at least 100 days after the procedure
Discuss fertility issues with the transplant team and learn about options (such as using a sperm bank or reserving eggs) because the treatment may impact the ability to have children in the future
Arrange for family needs (such as child care)
Meet with the pharmacist to review the medication regime (involving medications for before, during and after the transplant procedure)
Harvesting and Conditioning Procedures
Once a person has undergone the basic screening tests (which may last a few days) there are other steps that are necessary before the actual transplant procedure can be implemented.
You may take medications such as Mozobil (plerixafor injection) to help increase the number of circulating stem cells released from the bone marrow into the bloodstream. You will then undergo the harvesting procedure, either apheresis or bone marrow aspiration.
In peripheral blood stem cell harvesting by apheresis, a needle is inserted into a vein to draw out the blood from one arm. It passes through a machine that filters out the stem cells—which will be reserved—and the rest of the blood gets returned to your body into your other arm. A preservative is then added to the stem cells to sustain them during the time when they are frozen (stored for use later).
The bone marrow stem cell harvesting procedure is more involved. You will be scheduled for it to take place in an operating room and be under local or general anesthesia. A long needle is used to remove the stem cells from your hip bone, breastbone, or other sites. You will need to recover from anesthesia before returning home, and you may have some pain.
Next, you will undergo the conditioning process, which involves being administered high doses of chemotherapy and/or radiation therapy to kill the cancer cells. This can take two to eight days. You may have side effects from this treatment.
Transplant Process
In one to three days after the last dose of chemotherapy (or any time after the last radiation treatment) the actual stem cell transplant procedure will be scheduled.3 The transplant procedure itself is simple and painless (like a blood transfusion).
The procedure will take place in the hospital room and it takes around 45 minutes, depending on the volume of cells to be infused. Bone marrow transplants take much longer, up to a few hours.
The stem cells will be infused through a central line (a catheter inserted a large vein to allow for multiple procedures, such as drawing blood and infusing intravenous fluids and medications).
The nurse will keep a close eye on the blood pressure, temperature, pulse, and breathing rate, observing for side effects.
The recipient of an autologous stem cell transplant is awake during the entire procedure and can usually go home once it is complete (provided there are no complications or adverse reactions).
Side Effects
There are usually no side effects of an autologous stem cell transplant procedure,3 but occasionally patients report mild symptoms such as:
A strange taste in the mouth
Flushing
Nausea and vomiting
Fluctuations in blood pressure and breathing rate
It’s common that the urine is slightly blood-tinged within the initial 24 hours after the procedure.3 If the urine remains blood-tinged after the 24-hour time span, it’s important to report it to the nurse or other healthcare provider on the transplant team.
Delayed Side Effects
Approximately one week after the transplantation procedure, many recipients experience mild symptoms,3 these may include:
Fatigue
Mild flu symptoms (such as diarrhea, nausea or vomiting)
Loss of appetite
A change in the sense of taste or smell (from the chemotherapy)
A change in vision (due to side effects of some medications)
Sore throat or mouth pain (known as stomatitis or mucositis) from the chemotherapy
These mild symptoms usually resolve themselves in about two to three weeks after the procedure at the blood count begins to return to normal.3
Complications
More serious side effects after an autologous stem cell transplant may involve symptoms of infections such as:
Fever or chills/sweats
Continual or increased pain
Stiff neck
Shortness of breath
Productive cough (new cough or a change in cough)
Loose, watery stools and stomach pain
Blisters, sores or redness at the catheter site or sores in the rectal or vaginal area
Headache
Sore throat or new mouth sores
Painful or burning urination
A skin infection (such as an infected wound, hangnail or other red, swollen, flushed, red, painful area)
Pus or other types of fluid drainage (such as clear or blood-tinged fluid)
Other signs and symptoms of infection
Signs and symptoms of infection are the result of a low white blood cell count and must be reported to the members of the transplant team right away. Antibiotic therapy may be required.3
After the Procedure
After the autologous stem cell transplant, it’s important to have ongoing, close medical follow up care from the transplant team.4 Follow-up care and the final phase of recovery may take up to a year or even longer and may involve:
Observing for signs of organ complications (such as kidney problems)
Monitoring for symptoms resulting from a suppressed immune system
The need for wearing a medical alert bracelet (or other type of jewelry which can be ordered online
Frequent blood monitoring so the healthcare providers can track blood cell counts and evaluate how well the immune system is working
Infection Prevention
The chemotherapy or radiation conditioning treatments destroy your body's immune cells, and it takes time for the stem cell transplant to produce the white blood cells that fight infection.
It’s vital to try to avoid exposure to illnesses such as colds, chickenpox, herpes simplex (cold sores and genital herpes) shingles, or those who have recently been vaccinated with a live virus (such as chickenpox, rubella, or rotavirus vaccinations). If there is a known exposure to any of these types of viruses or infections, inform the transplant team members right away.
It’s important to take steps to prevent infection such as:4
Avoiding public places that are highly populated, using a mask when necessary
Eating a special diet that supports the immune system and avoids food that may harbor germs that could cause an infection
Bathing and washing with antibacterial soap
Frequent handwashing and good personal hygiene
Mouth care using a soft toothbrush until the platelet (blood clotting) cell count is high enough
Reporting a fever of 100.4 or higher or any other signs and symptoms of infection
Reporting signs of bleeding (from low platelet count) such as frequent bruising or nosebleeds, bleeding gums, petechiae (tiny purplish dots on the skin) or other symptoms.
Getting re-immunized with childhood vaccines (usually about a year after the transplant procedure).
Limiting the time in the sun and using sunblock (the skin may burn more easily after a transplant procedure).
Avoiding any type of body piercing or tattoos (which can increase the risk of infections such as hepatitis, skin infections or other types of infection)
Performing central catheter care as taught by the nurse on the transplant team
Reporting any problems with the central catheter (such as a break or leak in the catheter, redness, swelling, pain or other signs of infection at the catheter site)
Keeping the home environment clean and as dirt/dust-free as possible (without going to extremes)
Employing the help of someone (whenever possible) to keep the bathroom and other areas of the home clean and disinfected
Avoiding heavy cleaning (and other) chores such as vacuuming for several months after the transplant
Avoiding moldy areas (such as a damp basement)
Avoiding the use of humidifiers (which often grow bacteria)
Avoiding the use of alcohol (which may destroy the newly recovering bone marrow)
Avoiding the use of tobacco (which can increase the risk of lung infections)
Avoiding the use of herbal medicines and over-the-counter medications (unless approved by the healthcare provider).
Following the healthcare provider’s recommendation regarding activity and exercise
Avoiding travel for at least several months after the procedure
Returning to work or school in approximately two to four months after the transplant procedure (depending on the healthcare provider’s recommendation).
Prognosis
In a 2016 study of 85 lymphoma patients who received an autologous stem cell transplant procedure, the overall survival rate was around 65.7%. Those over 60 years of age were deemed to have a poor prognosis (predicted outcome).5
Another study published in 20126 found that the standard treatment of Hodgkin’s lymphoma relapse—involving high-dose chemotherapy and autologous stem cell transplantation—resulted in a five-year survival rate in 50% to 60% of the study participants.
Overall, getting an autologous stem cell transplant can raise your chance of survival. In fact, according to the Seattle Cancer Care Alliance, “It [stem cell transplantation] has boosted survival rates from nearly zero to more than 85 percent for some blood cancers.”7
Sources
Al hamed R, Bazarbachi AH, Malard F, Harousseau JL, Mohty M. Current status of autologous stem cell transplantation for multiple myeloma. Blood Cancer J. 2019;9(4):44. doi:10.1038/s41408-019-0205-9
American Cancer Society. Types of Stem Cell Transplants for Cancer Treatment.
UCSF Health. Autologous Transplant Guide: Treatment and Side Effects.
Memorial Slone Kettering Cancer Center. Returning Home After Your Autologous Stem Cell Transplant.
Sylvia Faict, Nathan De Beule, Ann De Becker, Karel Fostier, Fabienne Trullemans and Henri (Rik) Schots. Long-term Survival and Quality of Life Analysis after Autologous Stem Cell Transplantation for Lymphoma. Blood 128:2268
Colpo A, Hochberg E, Chen YB. Current status of autologous stem cell transplantation in relapsed and refractory Hodgkin's lymphoma. Oncologist. 2012;17(1):80-90.doi:10.1634/theoncologist.2011-0177
Seattle Cancer Care Alliance. How bone marrow transplants save lives.
By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.
Post comments