Treatment Overview

A stem cell transplant can use stem cells that come from your own blood or bone marrow. Or the stem cells can come from another person. When they come from you, it's called an autologous stem cell transplant.

Most stem cells are in your bone marrow. You also have some in your blood that circulate from your bone marrow. Bone marrow stem cells turn into red blood cells, white blood cells, or platelets to help your body stay healthy. If your bone marrow is attacked by a disease such as multiple myeloma, it can no longer make normal blood cells. A stem cell transplant may be used to replace damaged stem cells with new, normal stem cells.

A stem cell transplant may be needed to treat diseases, such as non-Hodgkin lymphoma and Hodgkin lymphoma, leukemia, multiple myeloma, and aplastic anemia.

In adults, most autologous transplants use stem cells from blood. In a child, the decision whether to use cells from the bone marrow or the blood depends on the child's size.

Using your own stem cells in a transplant is safer than using someone else's. That's because your body won't reject your own stem cells. But stem cells from your own marrow or blood may still contain some cancer cells. So the stem cells may be treated to get rid of any cancer cells before being put back into your body.

The autologous transplant process includes:

• Collecting stem cells. Your blood is sent through a machine that separates stem cells from your blood. The cells are stored until you need them for transplant.
• Having chemotherapy (sometimes along with radiation). This destroys cancer cells or damaged stem cells.
• Transplanting the healthy stem cells.
• Waiting for the transplanted stem cells to produce healthy blood cells.

How the stem cells are collected

Autologous stem cell transplants are done using peripheral blood stem cell transplantation (PBSCT). With PBSCT, the stem cells are taken from your blood. The growth factor G-CSF may be used to stimulate the growth of new stem cells so they spill over into the blood. G-CSF is a protein that is produced naturally in the body.

Your blood is removed from a vein and passed through a machine that separates the stem cells. The machine then returns the remaining blood through a needle in your arm or through a central vascular access device. This way of collecting stem cells is called apheresis.

In adults, most autologous transplants use stem cells from blood. In a child, the decision whether to use cells from the bone marrow or the blood depends on the size of the child.

What To Expect

Some people are able to get some or even all of their treatment in an outpatient clinic. Even if you need to be in a hospital, you probably won't need to stay longer than 3 weeks.

Severe, often life-threatening infection can occur after a stem cell transplant. You will need to take antibiotics for several months to prevent infection.

Your immune system may take 1 to 2 years or longer to recover after a transplant. Bone marrow aspiration or biopsy is used to check your bone marrow. You will need to have many vaccines updated. Check with your doctor to find out which ones you'll need.

Why It Is Done

Autologous stem cell transplant is used to treat many types of cancer, such as testicular or ovarian germ cell tumors, multiple myeloma, or lymphoma.

Who is a good candidate?

Your doctor will consider your health and your age. People who are good candidates for a stem cell transplant usually are younger than 70, do not have other diseases such as heart disease or diabetes, and have a normal kidney and liver. Your doctor will also consider how much your disease has grown and how aggressive your cancer is. People with aggressive cancer that has spread to many areas of the body usually aren't good candidates. Your doctor may also consider if you have cancer that has come back, such as relapsed non-Hodgkin lymphoma or leukemia.

How Well It Works

The success of a transplant depends on the type and stage of the disease and your age and general health.

The original disease may come back after the transplant. If relapse occurs after autologous transplant, chemotherapy or other treatments may be used.

Risks

Early complications usually occur within 5 to 10 days and include:

• Nausea and vomiting.
• Diarrhea.
• Mouth sores.
• Hair loss.
• Bleeding because of severe reduction in red blood cells, white blood cells, and platelets.
• Infection, such as pneumonia, shingles, or herpes simplex.

Other possible complications include:

• Depression.
• Infertility.
• Cataracts.
• Kidney, lung, and heart complications.
• Recurrence of your cancer.
• Other types of cancer later in life.