Autologous transplants

• Blood tests: Doctors measure the number of different blood cells by taking a blood test. This is called a blood count or full blood count. They will check your blood count often before, during and after treatment, because the treatment will affect the levels of your blood cells. 
• Before treatment, 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 clearing waste products from your body. 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. It is
  best to start the collection in the morning. When you wake up, pass
  your first stream of urine in the toilet as normal and note the time.
  Write this time on the bottle. From then on start collecting all of the
  urine you pass. Your collection finishes exactly 24 hours after the
  time you wrote on the bottle. It is important to collect all the urine
  you pass in the bottle. If you forget to pass urine in the bottle, the
  test will have to be repeated. 
• Dental check-up: Before you have the high-dose chemotherapy, a dentist needs to check your teeth. This visit might include having an X-ray of your teeth. Decaying teeth can cause a serious infection during your transplant. You can visit your own dentist for this checkup. Your doctors will need a letter from your dentist saying that you are dentally fit for the transplant.
• Infection testing: You will need to be checked for certain infections, which are not usually harmful but may cause problems after high-dose chemotherapy. This 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), an ultrasound of the heart)

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 you receive the high-dose chemotherapy, you will need a special line (thin tube) placed in a large vein. Having this line means there is no need for needles in your arms each time and it will save your veins from trauma. You might hear the line called a catheter by your nurses and doctors. 

Read more about central lines.

The time spent in hospital before, during and after a stem cell transplant will vary from person to person. But your treatment may impact significantly on your life. Before you begin your treatment, you may want to:
• Organise your finances, including any social welfare benefits you may be entitled to
• Talk to your employer about sick leave
• Organise childcare
• Ask a close friend or family member to provide updates to everyone else
• Organise help for when you are discharged from hospital

You can ask to speak with the medical social worker in your hospital
who can help you with some of these issues. Our Welfare and Support Service may also be of help. 

You will be given drugs to move your stem cells from your bone marrow into your blood.  The most common ways to do this are:
• Giving growth factors (G-CSF)
• Giving chemotherapy and growth factors (G-CSF)

When will the collection happen?

The ideal time to collect stem cells is when your white blood cells begin to rise rapidly. For this reason the transplant team will check your full blood count regularly. Your blood must also be tested for a special protein called the CD34 level. This level reads the number of stem cells in your bloodstream. Based on this result, the transplant team will know when your stem cells are ready to be collected.

There is a chance that your blood count may not ever rise to the level needed to collect the stem cells. There is also the chance that the number of stem cells collected is not enough to allow for future use. If this happens, other options will be discussed with you.

How are the stem cells collected?

The stem cells are collected using a machine called a cell separator (apheresis machine). This machine spins your blood at high speed to separate out the stem cells. The layer with the stem cells is collected into a sterile bag by the machine. The machine will also remove some of your plasma. Plasma is the pale yellow liquid part of blood minus the blood cells. The remaining blood is then returned to your body.

In general, each session takes around 3–5 hours. It may take a few sessions to collect enough, so this will happen over a few days.

The collected stem cells are mixed with a preservative called DMSO and frozen. 

How will I feel during the collection?

You will have a special needle in the bend of both your arms to carry the blood to and from your body. You will not be able to move your arms freely and will need to stay in one place to stop the needles moving or dislodging. But your arms will be in a comfortable, supported position.

If your veins are not suitable, you may need to have a temporary line put into a large vein in your neck, upper chest or groin. 

After the needles or line will be removed, you may notice some bruising and tenderness in the area but this should clear up within a few days.

Side-effects

Any side-effects are usually due to a change in the amount of blood in your system or the anticoagulant used. Side-effects can include:

• Feeling light-headed
• Feeling dizzy
• Nausea
• A sour taste in your mouth
• Tingling around your lips, fingertips and other sensitive areas
• Bleeding or bruising
• Tiredness

You will be admitted to a special hospital ward to receive your treatment. 

Usually you start high-dose chemotherapy the day after you are admitted to the ward.  All the bone marrow cells are killed off by the chemotherapy so you can receive new stem cells. 

How much chemotherapy you need and for how long will depend on your condition. It may last one or more days. Your transplant coordinator or specialist nurse will discuss this with you in more detail. 

The chemotherapy will be given into a vein through a central line. Once the chemotherapy is completed, you will have at least a 24-hour gap before your stem cells are given back to you.

The high-dose chemotherapy will cause your blood count to fall about 5 days after treatment. In particular, your white blood cells will be very low. This means your immune system will be less strong and you will be at risk of infection. This is why you will be nursed in isolation in a special ward or single room. 

You are likely to experience some side-effects from the chemotherapy. Read more about the side effects of stem cell transplants.

When will I get the stem cells back?

• Your stem cells are usually given back to you 1–3 days after the chemotherapy has finished.
• The day you receive the stem cells is known as Day 0 (zero). The staff measure your recovery starting from this day.

Getting the cells - reinfusion

• The stem cells are defrosted and then given through a drip into your central line.
  
  Before the reinfusion you will be given an antihistamine and steroid injection. This is given to prevent you having any allergic reaction to the preservative used to store the stem cells. 
• Receiving the cells is like having a blood transfusion, but there may be a number of bags to infuse. If you have more than 4‒6 bags of stem cells, you might receive them over 2 days. Usually the infusion lasts under an hour. You should not feel anything while the stem cells are being reinfused.

What happens afterwards?

• You may notice a strange taste and smell like garlic or boiled sweet corn after the infusion. This is due to DMSO, which is a preservative used to protect the cells while in storage. The smell and taste will clear within a
  day or two.
• You might feel some nausea.
• Your urine might turn red after the return of the stem cells as well. This will disappear within a few
  hours.
• You will start G-CSF injections. G-CSF will boost the growth of the infused stem cells and help them mature.  You will remain on this injection until your blood counts have recovered.

After your stem cells are given back to you, they find their way to your bone marrow and start to grow and make healthy new blood cells. 

• Engraftment means the stem cells moving into your bone marrow. 
• Your blood counts will be low while you are waiting for this to happen and you may need transfusions and antibiotics. 
• Usually after 10 to 21 days, your white bloods cells will start to recover.

Avoiding infection

• Daily blood tests will check the number of white cells, in particular, neutrophils. These neutrophils fight infection. 
• Your transplant team will try to protect you from possible infection so you will be looked after in a special ward or single room during this time. This is sometimes called protective isolation.

In general, visiting is restricted while you are in isolation. It is best that only your close family and friends visit you during your stay. 

Your hospital team will tell you about the other precautions your visitors should take to reduce the risk of you and other patients picking up an infection. For example, guidelines about handwashing and the need to stay home if they have a cough, cold or rash. 

Talk to your nurses and doctors if there is anything troubling you. For example, a sore mouth, being unable to eat or if you are feeling down. 

Your worries and concerns are important to them. 

If you don’t understand something you have been told, ask them to repeat it. They won’t mind explaining it again.

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 if they arise. 

You may be given a special diet to limit your exposure to bacteria in food. This is called a low microbial diet

It's important to be as mobile as possible and keep your muscles working. It's also 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. 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

Going home after your transplant can be difficult for you and your family. You have had a very intensive and often stressful procedure.

You may feel excited but you may also feel anxious about leaving
behind the care you received in hospital. 

This is all perfectly normal and there is no right way or wrong way to feel. 

In the days before you leave hospital, your nurses will help you with your plans for going home. Tell them about any worries you have.

If you have any questions after you go home, you can always call the transplant unit. It may be reassuring to hear a familiar voice.

If you have been referred from another hospital, after your discharge you will be referred back to your original doctor for follow-up care. Before you go home the transplant coordinator or specialist nurse will tell you if you need any further check-ups at the transplant centre.

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. 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.

 A special follow-up visit happens about 100 days (3 months) after the transplant. At this visit, you will have tests to check your disease and your health. 

It is likely that you will need follow-up for a long time after your transplant. This will depend on your original disease but you may need blood tests, bone marrow tests or scans. 
 

In some cases you may start consolidation or maintenance treatment once you have recovered from your transplant. These are treatments with anti-cancer drugs for a few weeks (consolidation treatment) or longer term (maintenance
treatment) to kill any remaining cancer cells and / or to try to increase the length of a remission. 

You need to contact the hospital immediately if you develop any of the symptoms listed below or if you if feel unwell in any way. It is very common for patients to be re-admitted to hospital in the weeks or months following discharge. Try not to feel worried or disappointed if this happens to you.

Central line

• Shivering episode after flushing your line
• Swelling, tenderness or pus around your line

Bowels

• Persistent diarrhoea or constipation
• Change in the colour or consistency of your stools (poo)
• Cramps

Urine

• Change in colour
• Pain or burning sensation
• Red urine, clots or difficulty passing urine

Skin

• Any kind of a rash
• Itching

Temperature/shivering

• Temperature over 38ºC, with or without shivering
• Shivering with or without a temperature

Pain

• A persistent headache that does not respond to paracetamol
• Stomach ache
• Gut cramps
• Joint pain
• Mouth ulcers or a sore throat

Nausea or vomiting

• Let the hospital know if this is new or is preventing you from drinking or taking your medication.

Medicine

• Let the hospital know if you’re unable to take your medication for any reason.

Bleeding

• Any signs of bleeding or bruising. For example bleeding gums, or blood in the urine or stools (poo)
• Persistent nosebleed

Cough or breathlessness

• A new or persistent or worsening cough
• Shortness of breath or increasing shortness of breath 

You must also contact the hospital if you have contact with anyone who has chickenpox, measles or shingles.

Once you are discharged, it can be hard to readjust to home life at first. You may feel a bit scared about going home. 

Even when you're at home, you might also feel separate or apart from your family and friends, but this is natural at this time. Remember you have just had an intense treatment and are leaving the security of the hospital. Naturally, you can feel anxious and afraid as a result. But planning and advice from your doctors and nurses can help to reduce those feelings and help you adapt.  

Once your white blood cell count has increased and you feel well enough, there is no reason why you cannot resume your social life. Going out can help you feel you are getting back to everyday life.

You will be more at risk of infections so avoid visiting people who have colds, sore throats or flu. It is best to stay out of very crowded spaces for the first few months to reduce the risk of infection. For example, shopping centres or crowded pubs, cinemas, clubs or concert venues. 

Once your blood counts are stable, you can think about returning to work, school or college. But you might not feel able for this for a couple of months after your transplant. 

As a rough guide, it is best to wait until at least 3 months after your transplant. Committing yourself to full-time work and all its pressures is often not a good idea. If possible, consider returning on a part-time basis at first to ease yourself gently back to normal life. Returning to work, school or college is a big step, so discuss it with your doctor. 

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. 

If your platelets or white cells are low, ask your nurse for advice about having sex. Your nurse can offer you help and support with issues affecting your sex life or close relationships.

Even though you are likely to be infertile after 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.

If you are planning a holiday, let your nurses know. In the immediate period after your transplant, it is best not to plan a foreign holiday. Any foreign travel should be discussed first with your doctor. 

You may need special holiday insurance in some cases. Depending on where you intend to travel, you may need certain vaccinations. But some vaccinations are not suitable after having a stem cell transplant. Always ask your doctor and nurse for advice. For any holidays abroad it is best to carry a letter giving details of your medical history and the hospital phone number in case of emergency.

It is normal to feel anxious about the transplant process. You might also be afraid that the treatment won't work or that your appearance, family or sex life might be affected.  You might feel uncertain about the future, and worry about going back to work or college. 

Being well prepared can make you feel less anxious and afraid. It can help to find out as much information as possible from your nurses. If you feel overwhelmed by your emotions it can help to speak to a trained counsellor or clinical psychologist. Some relaxation techniques can be useful in reducing anxiety. Ask your nurses for advice. 

There are many things that can give rise to frustration and disappointment. For example:
• Your blood counts are improving very slowly.
• You develop symptoms or side-effects and need to be readmitted to hospital.
• You are not getting better as quickly as you would like. 
• You need frequent check-ups or trips to the day unit after you come home.
• Ongoing tiredness and fatigue mean that you have no energy for doing things you enjoy.

Talk to your doctors and nurses if things are getting you down and remember that things such as fatigue and blood counts take time to improve. You can also call our cancer nurses on 1800 200 700. 

It common to feel very low after the transplant is over, especially in the early stages. You might also be feeling lonely or be worried about getting infections, about dying or your quality of life, or any ongoing health concerns. Talk to your nurses if you feel low or distressed. You can also call our cancer nurses on 1800 200 700 or visit a Daffodil Centre.

It can help to have support from your family and friends. It can also help to join a cancer support group so you can express your emotions and worries. 

Your nurses can arrange for you to talk to a clinical psychologist if you are feeling distressed or depressed. Sometimes your doctor might prescribe antidepressants if they think it might be helpful.  

Read more about coping with depression.