Also known as Autologous Hematopoietic Cell Transplant, Autologous HCT, or Autologous BMT.
An autologous stem cell transplant uses your child’s own healthy blood-forming stem cells. Stem cells are made in the spongy part of bones, called bone marrow. They make all types of blood cells in your child’s body.
What is an autologous transplant?
An autologous transplant uses your child’s own blood-forming cells (stem cells) to replace cells that are damaged or destroyed by high doses of chemotherapy or radiation.
Before your child starts their high-dose therapy, the care team will collect some of your child’s own blood-forming stem cells. The stem cells are processed and frozen for later use.
After your child's stem cells are collected, they will receive chemotherapy or radiation to treat their disease.
After your child finishes their treatment, they will receive their own stem cells to replace blood cells destroyed by the treatment. The stem cells will travel to their bone marrow, where they will grow and make healthy red blood cells, platelets, and white blood cells. This is known as engraftment.
Conditioning or preparative treatment using chemotherapy or radiation
Infusion of your child’s stem cells
Engraftment
Supportive care to manage side effects
Pre-transplant testing and evaluation
Your child will be evaluated by their care team before the transplant. The transplant process and recovery are physically and emotionally challenging. The medical team will do tests to make sure your child is a good candidate for the transplant.
Your team will consider factors such as:
Your child’s diagnosis
Your child’s age
Medical history
Health of your child's heart, lungs, and other organs
Prior treatment history
Pre-transplant tests may include a complete medical exam, blood tests, and imaging studies such as CT scans, MRI, or X-rays.
Your child will also have a central line for chemotherapy and medications during the transplant process.
Stem cell collection occurs through a procedure called apheresis.
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 (apheresis)
Your child will receive a type of medicine called granulocyte colony-stimulating factor (G-CSF, also called Filgrastim). G-CSF helps the bone marrow make more stem cells and move them from the bone marrow into the bloodstream.
The cells are collected using a procedure called apheresis. During apheresis:
A small amount of blood is removed through a vein in your child’s arm with an IV 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 stem cells.
The remaining blood is given back to your child.
Apheresis usually takes about 4 to 6 hours.
The stem cells are processed in the lab, frozen, and stored until your child is ready for their transplant.
Bone marrow is harvested from your child’s hip using a hollow needle attached to a syringe. Your child will be under general anesthesia for the procedure.
Collecting stem cells from the bone marrow
A bone marrow harvest is done in an operating room with general anesthesia, so your child will be asleep. The procedure usually takes about an hour.
Doctors insert a needle into a bone (often the pelvis) to remove the marrow.
The bone marrow is processed in a lab to collect the stem cells.
The stem cells are frozen and stored until your child is ready for their transplant.
After this procedure, your child may have pain, stiffness, bruising, or swelling in the area. Most side effects are mild and go away in a few days.
Conditioning or preparative regimen
To prepare for transplant, your child goes through a process called conditioning or a preparative regimen. Conditioning usually involves high-dose chemotherapy. In some cases, conditioning may also include radiation therapy, either total lymphatic irradiation (TLI) or total body irradiation (TBI). The goal is to kill any cancer or abnormal cells left in the body.
Patients may have side effects from the conditioning regimen. These may include:
The transplant team will watch for side effects. Your child may receive treatments to help prevent or manage them.
Infusion of stem cells
After conditioning, your child’s stored cells are given back to them by an infusion into their bloodstream. This is similar to getting a blood transfusion. Your child is awake during this process. Their cells are in a bag or syringe connected to their central line. It only takes a few minutes to a few hours, and it is not painful.
Your child 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, they may have a change in blood pressure or trouble breathing.
Your child will receive their own, harvested stem cells into their vein by infusion. The stem cells travel through the bloodstream to the bone marrow and make healthy red blood cells, white blood cells, and platelets.
Engraftment of stem cells
The goal of the transplant is for the infused stem cells to travel to the bone marrow and begin to make more stem cells. The stem cells become white blood cells, red blood cells, and platelets. This is called engraftment.
Engraftment generally takes 2-5 weeks, but the time can vary. Neutrophils (a type of white blood cell that fights infection) grow and engraft first, followed by platelets and then red blood cells. Your child may get medicines to help with engraftment.
During this time, your child will have frequent blood tests, such as a complete blood count test, to check the number of red blood cells, white blood cells, and platelets. A bone marrow aspiration and biopsy may be done to see how well the bone marrow is making new cells.
Your child may also need to get transfusions of blood products until they can make enough of their own.
Supportive care after transplant
Your child will get supportive care during the transplant process. This may include:
Infusions of platelets and red blood cells
Medications to prevent or fight infection, such as antibiotics, anti-viral, or anti-fungal medicines
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.
Side effects that may occur after an 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)
The disease may come back (relapse) or get worse (progression) if the transplant is not successful.
Caring for your child after autologous transplant
Your child will stay in the hospital until neutrophil engraftment occurs. A parent or adult family member will need to stay with your child while they are in the hospital. Your child will stay in local or long-term housing for several weeks to months after hospital discharge. After discharge, your child will have regular outpatient clinic visits and lab tests several times a week to check their progress.
Your care team will teach you how to care for your child after transplant. It is good to have more than 1 family member who can be trained and available to help care for your child.
To help your child recover and stay healthy after transplant:
Take steps to prevent infection. Your child will have a very weak immune system for weeks after the transplant. Avoid public areas, wash hands often, limit visitors, stay away from people who are sick, and wear a mask as instructed.
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 changes in condition.
Give medicines as instructed. Let your care team know if your child has any problems taking medicines or keeping them down.
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A stem cell transplant (bone marrow transplant) may be used as a treatment for some childhood cancers and blood disorders. Learn more about stem cell transplants.
The immune system is the body's defense against infection. A network of special cells, tissues, and organs work together to protect the body from a variety of "invaders" or germs.
