What is involved in having an autologous stem cell transplant?

What is involved in having an autologous stem cell transplant?

My name is Joan Peery. I live in Austin, Texas, and I was transplant at Saint David's South Transplant Center with Doctor Ramakrishnan. I first had MGUS, and then all of a sudden my numbers after two years went up drastically. He put me in a daratumumab study, and I did that for four months. And then the conversation of stem cell transplant came up after my numbers got down, and he just suggested that I go and talk to Doctor Ramakrishnan, who was the stem cell transplant doctor. And so my husband and I went over and talked with him. And, we both decided that the stem cell transplant was the best option for me. As much education as possible is important.

When I counsel patients, I spend at least an hour and a half with them, telling them about the process of what happens during the procedure, what they can expect. We give them calendars that basically map out exactly when we expect certain side effects to happen. We tell them about what to do at home. Who they need to stay with. If the procedure can be done as an outpatient or it can be done in the hospital. Transplant can be done inpatient or outpatient. Most of the time where we do it depends on medical factors, social factors, insurance. Sometimes age is an issue. But as long as patients have social support, they have a caregiver that can bring them back and forth to the clinic. They're healthy. They don't have lots of medical conditions. Almost every patient can have this procedure as an outpatient.

While we scheduled the transplant. My particular insurance actually wanted me to have more tests, and they wanted me to stay in the hospital for at least 15 days. I really liked being in the hospital. That felt more comfortable to me.

If they start getting sick where they need continuous I.V. fluids or some more support for I.V. antibiotics, we can always admit them, but we try to do as many outpatient procedures as possible. The best place to heal is at home. The best place to sleep is in your own bed, not a hospital bed. Your infectious risk is also lowest at home as opposed to the hospital. Some patients don't have that availability of caregiver support, but they don't have anyone that can drive them to the clinic. Every day while the patients are going through transplant, they can't drive. So for those patients, they end up in the hospital.

How can patients learn about what to expect during transplant?

There are support groups and online resources that help patients get educated about the process. Talking to other people who have gone through it is always helpful because it gives you a firsthand perspective of how someone else felt when they went through the procedure as well.

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What was really good for my husband? What they had at the hospital was a support group for the caretakers. So my husband went to that support group and he learned a lot about that. And he also met people, that were caregiversthat, helped supported him and what he was going through. And they did that at the hospital.

What is the transplant process?

As far as the process of the transplant, many patients can undergo the procedure as an outpatient. The first part of the process is harvesting stem cells and freezing them away. At our center, we typically do that with just something called growth factor. These are injections that we give under the skin. These injections mobilize bone marrow stem cells from the bone marrow out into the blood. And then we can suck them out of the blood. Using a machine and a process similar to dialysis. And this is entirely an outpatient procedure. It sometimes requires a special type of catheter to be placed into the jugular vein, so that the machine can process enough blood and collect enough stem cells. I went in there and they before the transplant. What they do is they put a central line in. They gave me a ride to push the stem cells out of my bone marrow, which was no big deal. Some people say it hurts. The bones start hurting it. Aches. Mine never did that. Then I went in for collection day is what they call it. And they hooked me up to the machine. And from the central line, my blood went through it. They pull out the stem cells, and I had wonderful pink lights and enough stem cells for three transplants. It took a day, like maybe six hours, maybe. And then I was done.

Once those stem cells are collected, they're frozen away. We typically try to collect for at least two transplants in most patients. And once the cells are frozen, then, the patients are ready to move forward with the chemotherapy. And transplant procedure. So again, typically we place some sort of IV catheter that is semi-permanent so that the chemo can be administered. Before the transplant. Then they give you a week to relax.

And you know, and during that time what they do is then they put a central line in your arm because I did not have a PICC line. So they put a PICC line in. And then I was in the hospital and the first day I was in and got to know people, that settled in to the hospital setting. The chemo that we typically use is a drug called melphalan and we give it at very high doses. It's a very short infusion. It goes very quickly. We give lots of medications to prevent nausea, vomiting, and patients usually tolerate it very well. We wait for about a day for the melphalan to go in and do its job and kill all the myeloma cells, and it will also kill some of the bone marrow stem cells. And once it's kind of processed through the body and eliminated, then the frozen stem cells are thawed and infused into the patient. Usually that infusion is very fast over a period of 5 to 10 minutes. The first day they started with, antibiotics and a fungal type resistant drug. The next day they put the machine up, they put the melphalan in to my arm. And, then they had the machine in, and then they just put, my stem cells back in. They suggested that the whole time I'm getting melphalan and, going to that procedure that I suck on ice because that prevents, sores in your throat, in your esophagus. And so I was able to do that. I never got the sores. So I highly suggest that people do that also. I never got neuropathy.of what people said that they would get.

Then there is a period for about a week where patients are experiencing some of the side effects of the chemotherapy. The chemotherapy, damages the gut, and people have some mild diarrhea and also their, bone marrow goes into failure because the new stem cells that we put in are typically like seeds that need some time to go into the bone marrow and develop and grow. And that process usually takes about 11 to 14 days. So there's a period, where, they sometimes feel like they have a bad flu. I don't want to get up very much, not eating as much or drinking as much. And we support them with intravenous fluids and support and antibiotics to prevent infections. And almost everybody gets through that period without any major complications. And then once those stem cells kick in, everything starts getting better. Patients recover this procedure is so well oiled at this point. At most transplant centers, it can be done entirely as an outpatient over a period of three weeks, and then patients can return to their physician for further care and maintenance therapy.

Overall, I would pretty much say my stem cell transplant couldn't have gone any better than what I did. And so if I had to do it again, I would do it again. The only problem that would bother me is that I will have to regrow my hair again, because it's a melphalan does take out your hair. And that was the most struggle I had was growing back my hair. 

For more information about autologous stem cell transplant side effects, visit our HealthTree University website. Go to the Care and Treatment module and click the updated Autologous Stem Cell Transplant Course.