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Autologous Stem Cell (Bone Marrow) Transplant

Also known as Autologous Hematopoietic Cell Transplant, Autologous HCT, or Autologous BMT

bone marrow medical illustration showing bone marrow, blood stem cells, platelets, red blood cells, and white blood cells

"Auto" means "self." An autologous stem cell transplant uses healthy blood-forming stem cells from the patient. These cells are known as hematopoietic stem cells. Stem cells are made in the spongy part of bones, called bone marrow. They make all types of blood cells in the body.

What is an autologous transplant?

An autologous transplant uses a patient’s own blood-forming cells (stem cells) to replace cells that have been damaged or destroyed by high doses of chemotherapy or radiation.

Before high-dose therapy begins, the patient donates their own healthy blood-forming stem cells. The cells are processed and frozen for later use. The patient then receives chemotherapy or radiation to treat their disease. After treatment, patients receive their own stem cells to replace those that were destroyed.

The stem cells travel to the bone marrow. They grow and make healthy blood cells, including red blood cells, platelets, and white blood cells.

Learn about transplants using donor cells from other people:  allogeneic stem cell transplant.

Diseases autologous transplants treat

Autologous transplants are used for certain cancers, including:

Steps of an autologous transplant

The autologous transplant process involves:

  • Pre-transplant testing and evaluation
  • Collection of stem cells (harvesting)
  • Conditioning or preparative treatment using chemotherapy or radiation
  • Infusion of the patient’s stem cells
  • Engraftment
  • Supportive care to manage side effects

  1. Pre-transplant testing and evaluation

    Your child will have an evaluation before transplant. The transplant process and recovery are physically and emotionally challenging. The medical team will do tests to make sure your child is good candidate for transplant.

    Your team will consider factors such as:

    • Age of your child
    • Medical history
    • Health of your child's heart, lungs, and other organs
    • Diagnosis
    • Prior treatment history

    Pre-transplant tests may include a complete medical exam, blood tests, and imaging studies such as CT, MRI, or X-ray.

    Your child will also have a central line for chemotherapy and medications during the transplant process.

    Other care team members may include child life specialists, social workers, psychologists, and palliative care specialists.

  2. Stem cell collection (harvesting)

    Blood-forming stem cells are usually collected from the blood. In some cases, the cells are taken from the bone marrow.

    Collecting stem cells from the blood

    • Patients receive a type of medicine called granulocyte colony-stimulating factor (G-CSF). G-CSF stimulates the stem cells to move from the bone marrow into the bloodstream. Other medicines may also be given.
    • The cells are collected using a procedure called apheresis. In apheresis, blood is removed through a vein in the arm or from a central venous catheter (a flexible tube that is placed in a large vein in the neck, chest, or groin area). The blood goes through a machine that removes the cells. The remaining blood is then given back to the patient. Apheresis typically takes 4 to 6 hours.
    • The stem cells are processed, frozen, and stored until the patient is ready for the transplant.

    Collecting stem cells from the bone marrow

    The procedure is done in an operating room under general anesthesia.

    Doctors insert a needle into a bone (often the pelvis) to remove the marrow.

    The bone marrow is processed to collect the stem cells.

    The stem cells are frozen and stored until the patient is ready for the transplant.

    apheresis image showing saline bag, stem cells bag, apheresis machine

    Stem cell collection occurs through a procedure called apheresis.

  3. Conditioning or preparative regimen

    To prepare for transplant, your child will go through a process called conditioning or a preparative regimen. It usually involves high-dose chemotherapy. Conditioning may also include radiation, either total lymphatic irradiation (TLI) or total body irradiation (TBI).

    The goal is to kill any cancer cells left in the body. The treatment also kills healthy blood-forming stem cells.

    Patients may have side effects from the conditioning regimen. These may include:

    The transplant team will watch for side effects and give treatments to help prevent or manage them.

  4. Infusion of stem cells

    After the chemotherapy or radiation treatment, your child’s stored healthy blood-forming cells will be thawed. The cells are then given back to your child through a vein into the bloodstream. This process is called an infusion. It is much like a blood transfusion. Your child is awake during the infusion.

    Some patients may have side effects from the infusion. This is due to a chemical used to preserve the frozen cells. Side effects may include a strange taste or smell, nausea or vomiting, or a change in urine color. Rarely, patients may have a change in blood pressure or trouble breathing.

    Hematopoietic cell transplant illustration of female patient in hospital bed with saline and stem cells IV bags

    There are two basic types of transplants: allogeneic (blood-forming cells come from a donor) and autologous (the patient’s own cells are used). A patient receives cells from the donor through a vein in a process much like a blood transfusion. The cells travel through the bloodstream to the center of the long bones. The transplanted cells restore the patient’s ability to make healthy red blood cells, white blood cells, and platelets.

  5. Engraftment of stem cells

    After the infusion, the infused stem cells travel to the bone marrow and begin to divide to make new stem cells. The blood-forming stem cells become white blood cells, red blood cells, and platelets. This is called engraftment.

    This process may take 2-5 weeks. During this time, your child will have frequent blood tests to monitor the numbers of red blood cells, white blood cells, and platelets. Your child may receive medicines to promote engraftment.

    Neutrophils (a type of white blood cell) engraft first, followed by platelets and then red blood cells.

  6. Supportive care after transplant

    Your child will receive supportive care during the bone marrow transplant process to help manage side effects. This may include:

    • Infusions of platelets and red blood cells
    • Medications to prevent or treat infection, such as antibiotics, anti-viral, or anti-fungal medicines
    • Medication to prevent nausea and vomiting
    • Pain medicines
    • Nutrition support

Risks of an autologous transplant

Patients receive their own cells, so there is no risk that the immune system will view the transplanted cells as foreign and attack or reject them. 

Possible problems after autologous transplant include:  

  • Side effects from chemotherapy or radiation therapy used during conditioning or as part of treatment  
  • Infection because of a low white blood cell count (neutropenia)  
  • Weakness or fatigue caused by fewer red blood cells (anemia)
  • Increased risk of bleeding or bruising caused by low platelets  (thrombocytopenia)
  • Graft failure if the cells do not grow well (this is very rare) 
  • Disease relapse or progression

Taking care of your child after autologous transplant  

  • Watch for signs of infection or illness. Call your doctor if your child develops a fever or symptoms such as rash, mouth sores, bruising or bleeding, trouble breathing, headache, or other change in condition.
  • Give medicines as instructed. Let your care team know if your child has any problems taking medicines or keeping them down.
  • Your child will have a very weak immune system for weeks after the transplant. Take steps to prevent infection. Avoid public areas, wash hands often, stay away from people who are sick, and wear a mask as instructed.
  • Follow your child’s mouth care plan.
  • Make sure your child has a daily bath.
  • Encourage your child to be active throughout the day as they are able.
  • Let your care team know if you have any questions or concerns.
  • Avoid sun exposure when possible. Protect the skin from the sun and use sunscreen with a SPF of 30 or higher.

Key points about autologous transplant

  • An autologous transplant uses a patient’s own blood-forming stem cells.
  • Autologous transplant steps include pre-transplant testing and evaluation, conditioning, infusion, and engraftment,
  • Blood-forming stem cells are usually collected from the blood. In some cases, the cells are taken from the bone marrow.
  • After the conditioning treatment, the cells are given back to the patient through an infusion.
  • The patient’s infused stem cells travel to the bone marrow and begin to divide to make new stem cells.
  • The blood-forming stem cells become white blood cells, platelets, and red blood cells.

–
Reviewed: August 2022

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