Stem cell transplants using your own stem cells (autologous transplants)

• Blood tests: Blood tests can show the numbers of different types of blood cells. This is called a full blood count. Doctors will also check your blood group, clotting and iron levels and how well your kidneys, liver and bones work. They will also check for the presence of viruses, for example, HIV, hepatitis A, B, C and syphilis.
• 24-hour urine collection: This test checks how well your kidneys are working. You will be given a large plastic bottle to bring home with you to collect your urine. You will be asked to collect all the urine you pass in a 24-hour period. You do this at home. It is important to collect all the urine you pass in the bottle or the test will have to be repeated. To measure the results, you will need a blood test taken when you return the urine collection to the hospital.
• Dental check-up: Before you have the high-dose chemotherapy, a dentist needs to check your teeth. This is because decaying teeth can cause a serious infection during treatment. You can visit your own dentist for this check-up. Your doctors will need a letter from your dentist saying that you are dentally fit for the transplant
• Testing for bacteria: Certain bacteria which are not usually harmful may cause infection after high-dose chemotherapy. Tests will help your doctor choose the correct antibiotics if you do become unwell.
• Lung function tests
• Chest X-ray
• Heart tests (ECG and echocardiogram (ECHO)

You may have other tests, depending on your condition and medical history. For example, bone marrow biopsy and lumbar puncture. Read more about cancer tests.

Before your high-dose chemotherapy, you will need a special line (tube) placed in a large vein. Any treatment or medication that needs to go into your veins can be delivered through the line, meaning there is no need for needles in your arms every time.  It can stay in place during and for a time after your treatment. Read more about central lines.

You may have chemotherapy before your stem cell collection, to reduce the number of cancer cells.

You will have growth factor (G-CSF) injections for several days to make the stem cells move from the bone marrow into the blood, so that they can be collected from the blood. This is called mobilising the stem cells. If you have chemotherapy this can also help to mobilise the stem cells.

You will be shown how to give yourself the injection, or a family member or public health nurse can do it. The growth factors are given as a daily injection under your skin for several days.

The most common side-effect of these injections is bone pain. This usually happens in the chest, back and hip area and is a spasmodic type of pain. The pain is usually relieved by simple painkillers such as paracetamol. However, paracetamol may mask or hide a fever. If you feel unwell in any way, the best advice is to contact your hospital. Other side-effects include flu-like symptoms, tiredness, headache, sleeplessness and irritability. Occasionally, a slight tingling sensation, redness and bruising may occur at the injection site. Sometimes G-CSF can cause allergic reactions, which can be easily treated.

High-dose treatment can affect your ability to have children in the future. Talk to your medical team before treatment if this is important to you. It may be possible to freeze your eggs or sperm.

You might find it difficult being on your own without other patients around you. Your nurses can help you overcome these difficulties. They can arrange for you to talk to a clinical psychologist to try to help you cope.

You will have daily blood tests, especially to check the number of white cells called neutrophils, which fight bacteria.

Usually after 10–21 days, your blood counts will start to recover. You can go home once your blood cells have recovered enough and you don’t have side-effects that need treatment in hospital.

 

Good nutrition can help to prevent you picking up any infections. You should try to eat, even if you have nausea or lose your appetite. The hospital dietitian can discuss the best way to deal with these problems. You may be given a special diet called a low microbial diet to limit your exposure to bacteria in food. 

Keeping active helps to keep your muscles working and is important for your lungs. Get up and walk around the room at least a few times a day. Even getting up to go to the toilet and to wash yourself helps with your recovery. You will be allowed to exercise and the occupational therapist or physiotherapist may plan an activity programme for you. You may be allowed out of the room for short periods when your blood count has started to rise.

For the first few weeks after your transplant you may have to return to the day ward for blood tests. This is to check your blood counts and to make sure your liver, kidney and bones are working well. But in general, your blood tests will come back to normal quickly after discharge. You might need a blood, platelet or magnesium or potassium infusion in the weeks after the transplant. Once your blood counts are stable and your strength is improving, you will have fewer visits to the hospital.

These check-ups after treatment are called follow-up. It is likely that you will need follow-up visits for a long time after your transplant. This will depend very much on your original disease but you may need blood tests, bone marrow tests or scans. 

Contact the transplant centre or your referring hospital if you have any of the following problems at home:

• A fever of more than 37.5°C
• Uncontrolled shivering
• A runny nose or flu or a cold
• Red or tender areas, or yellow/green ooze, around your central line
• Nausea, vomiting or diarrhoea
• An unusual or itchy rash or sore
• Bleeding or bruising. For example, blood in your urine, coughing up blood or nose bleeds
• A persistent headache

The first sign that the transplant has worked is when your blood counts increase. A special follow-up visit happens about 100 days (3 months) after the transplant. At this visit, your doctor will check how your disease is behaving. Depending on your diagnosis, this visit may take place at the transplant centre or at your referring hospital.

Your transplant coordinator will organise any tests you need for this follow-up appointment with you or your referring hospital. These may include blood tests, a CT scan and a bone marrow biopsy. You will also need blood tests to check your hormone levels, thyroid function and immunity levels. 

 

Your central line can usually stay in until your blood counts are high enough to allow it to be removed. If the line needs to stay in place, you or a family member will be shown how to care for it at home. It will also need to be cared for weekly with a flush and dressing change on the day unit.

 

You will have medications to take at home. Some of the common ones are:

• Anti-sickness medication, but you may not experience nausea or vomiting at all
• Antacid – to treat heartburn
• Antibiotics to protect against a particular strain of pneumonia
• Anti-viral drugs to protect against the cold sore and shingles virus

Continue to take any medications you are given until your doctor decides to stop them.

For the first few weeks after the transplant your energy levels will be very low. Fatigue can be a frequent and unpleasant side-effect. You will probably find you have no energy and do not feel like doing anything at first. Just getting up, washed and dressed can be a challenge in the first few weeks. Don’t be expect too much from yourself – take one day at a time. This tiredness can last for a few months but sometimes can take longer to overcome. Read more about coping with fatigue.

 

Even if your blood counts are back to normal, your immune system takes a little longer to recover. Continue to be careful. For example:

• Continue to shower every day and be strict about your personal hygiene.
• Continue your mouthwashes until your next visit to the day ward.
• Avoid people with infections.
• Avoid areas that are overcrowded.
• Avoid close contact with pets, especially birds, in the first few weeks.
• Avoid swimming if you go home with your central line in place.
• Keep your fridge clean.

You may find that you don’t have much appetite or your taste and sense of smell has changed. Foods that you loved before might now begin to taste and smell different. Try not to worry as your appetite and taste will gradually improve. It’s important to eat as well as you can, so ask to talk to the hospital dietitian if you’re experiencing problems or losing weight. We also have advice on eating difficulties, including tips to help if your appetite is poor. 

Aim to drink 2 to 3 litres of fluid a day to speed up your recovery. Your mouth may continue to feel dry after your transplant so drinking plenty of fluids will also help with this. Often it is best to avoid alcohol for a time after your transplant. Talk to your doctor for more advice about alcohol.

 

It is likely that after your transplant your sex life will be affected in some way. Tiredness, anxiety and lack of interest can often be the reason. It is likely that once your energy levels return to normal so too will your sex drive (libido). If your platelets or white cells are low, ask your nurse for advice about having sex. Your nurse can help and support with issues affecting your sex life or close relationships.

Even though you are likely to be infertile after the high-dose chemotherapy, there is no guarantee that it will happen. Research suggests that a small number of patients can recover fertility after a transplant. It is important to use reliable contraception such as a condom after chemotherapy to avoid pregnancy. This is because the drugs might harm a developing baby. Your doctor or nurse will advise you to use reliable contraception for a few months afterwards.