Learn More: Bone Marrow & Stem Cell Transplant Treatments
What are bone marrow blood stem cells?
Every blood cell starts from a special kind of cell called a bone marrow stem cell. Your bone marrow makes blood cells.
The cells in our blood do several vital things:
- White blood cells (WBC or leucocytes) fight infections
- Red blood cells (RBC or erythrocytes) carry oxygen
- Platelets help blood to clot and stop bleeding
The process of blood cell growth is called hematopoiesis.
How does an autologous stem cell transplant work?
Some types of cancer are best treated with higher doses of chemotherapy. But, such a high dose of chemotherapy can reduce the number of blood cells growing in the bone marrow.
We can give people higher doses of chemotherapy if we collect and safely freeze their bone marrow stem cells first. A few days later, when the chemotherapy is gone from the body, we can thaw and reinfuse their own bone marrow stem cells. The “transplanted” stem cells begin to grow in the bone marrow. After a few weeks, the bone marrow stem cells produce normal numbers of blood cells.
Who might need an autologous stem cell transplant?
Autologous stem cell transplant is often an option for people who have received other treatments already. Autologous stem cell transplant is a standard treatment option for people diagnosed with Multiple Myeloma and some types of Lymphoma. It may help people with other cancer types, too. Not everyone with these cancers will need a transplant.
It may also be an option if it is likely to extend a person’s survival time or cure them of their cancer.
If an autologous stem cell transplant is a treatment option for you, our UNM Transplant team is here to support you. Stem cell transplantation is complex. You may find the process physically and emotionally difficult. We will guide you and help you through your evaluation and treatment process.
If an autologous stem cell transplant is a treatment
option for you, our UNM Transplant team is here to support you.
You can ask our team questions: call 505-925-0062.
What are the other types of blood stem cell transplants?
The UNM Cancer Center performs autologous stem cell transplants. An autologous stem cell transplant uses a person’s own stem cells. Another type of transplant, called an allogeneic transplant, infuses blood stem cells from a donor.
UNM does not currently perform allogeneic transplants. We care for people before and after they have received an allogeneic transplant at other cancer centers. People who receive allogeneic transplants often require specialty care for many years after their treatment.
Pre-transplant evaluation
A transplant physician will review your medical history and preferences with you to decide if an autologous stem cell transplant will help you. If the transplant physician thinks a transplant will help you, and if you decide you would like to undergo a transplant, we will perform several tests to make sure you are healthy enough to tolerate the procedure.
We will test how well your heart, lungs, liver and kidneys work and will test to see if you have any infections. We will also ask you about staying close to the UNM Cancer Center and about whether you can get regular support from caregivers while you are being treated in the outpatient clinic.
Stem cell collection (harvest)
Once you have been cleared to begin an autologous stem cell transplant, we will begin the treatment by collecting bone marrow stem cells from your blood. To collect these cells:
- We will place a central venous catheter in you. A catheter is a tube that we will insert into one of your veins.
- We will give you drugs that make your bone marrow stem cells leave your bone marrow and flow into your blood
- We will collect your bone marrow stem cells through your catheter using an apheresis machine.
Processing and storing your cells
We will prepare and ship your bone marrow stem cells to a specialized processing lab.
At the lab, your bone marrow stem cells are counted and carefully frozen. The freezing process allows them to be stored for many years.
During your transfusion, bags of stem cells are thawed in a warm water bath minutes before they are transfused.
Stem cell transplantation
When your bone marrow stem cells are safely frozen and stored, you can receive chemotherapy to treat your cancer. Once you finish your chemotherapy, your bone marrow stem cells will be thawed and reinfused into you through an IV line. The infused stem cells will help your bone marrow to start making blood cells again.
Recovery period
Once your stem cells go back into your blood, they find their way back into your bone marrow. Once in your bone marrow, they start to grow and make blood cells again. This process usually takes several weeks.
Often people need to stay in the hospital for the first two to three weeks after their transplant. If needed, you will stay at UNM Hospital after your transplant. Within a couple of days after your discharge from UNM Hospital, our team will follow up with you. We will continue to follow up with you often for some time.
Long term follow up
- You may take several months to fully recover your strength and energy.
- We strongly suggest you get vaccines to rebuild your immune system during your recovery.
- A transplant physician will talk with you and your cancer doctor about maintaining your long term health.
Download and print Stem Cell Overview information: English • Spanish
An apheresis machine is used to collect your stem cells.
Getting to your bone marrow stem cells
Stem cells are the blood-forming cells that reside in the bone marrow. Collecting the bone marrow stem cells is the first step of the transplant process. For an autologous transplant, you will donate your own stem cells (a stem cell collection), which will be given back to you after you have completed chemotherapy.
The most common way to collect the stem cells is to use medication that causes the stem cells to leave the bone marrow and circulate in your bloodstream. This process is called stem cell mobilization. From your bloodstream, we collect your stem cells through an IV.
The medication most commonly used for stem cell mobilization is called Filgrastim, or GCSF, for Granulocyte Colony Stimulating Factor. It is given as an injection under the skin once daily. By the fifth day of fligrastim treatment, most patients will have enough stem cells in their blood stream to begin the collection procedure.
Another way to mobilize your bone marrow stem cells is to give you chemotherapy first and then GCSF injections. You may need to stay in the hospital for the chemotherapy. You can usually get the GCSF injections and stem cell collection at the UNM Cancer Center outpatient clinic. The transplant physician will determine the best mobilization regimen for you.
Stem cells are collected by connecting an IV to an apheresis machine. The apheresis machine separates your bone marrow stem cells from the other cells in your blood and then returns the remaining blood back to your body. We will place a central venous catheter into a large vein in your body. This catheter can be used for both the collection and the transplant.
Your Transplant Nurse Navigator will give you a schedule that lists your procedures and appointments.
What to expect during your collection process
A nurse connects the stem cell harvest machine to your catheter. The central venous catheter is placed into a large vein in your body before the day of your stem cell harvest.
- You will come to the UNM Cancer Center and we will draw blood samples to check whether you are ready to start collection.
- If the number of stem cells in your circulation is too low, we might give you an additional medication to help move your bone marrow stem cells into your bloodstream. One common medication for this is called Plerixafor. If there are enough stem cells in your bloodstream to begin collection, we will connect the apheresis machine to your catheter.
- The apheresis machine will circulate your blood through the machine, remove the stem cells from your blood, and store them in a transfusion bag. The rest of your blood will be returned to you. Your blood will be circulated through the machine several times in order to collect enough stem cells. We’ll use a small amount of blood thinning medication to prevent blood clots.
- The collection process takes about three to four hours. An apheresis nurse will be with you during the entire process.
- You should feel no pain during the apheresis process. You may, however, feel tingling or muscle cramps due to changes in your calcium levels. Your nurse can treat any tingling and cramps you feel with Calcium given through your IV line, so tell your nurse if you feel anything.
- In some cases the apheresis machine will also remove some of your red blood cells or platelet during the process. These counts will be checked at the end of collection.I If your red blood cells or platelets are too low, we will give you a transfusion after the apheresis process.
- Although the procedure is usually well tolerated, you should have a caregiver available to give you a ride home afterwards.
If we don’t collect enough bone marrow stem cells from you, we will need you to repeat the collection process each day, for the next one to four days.
Once the stem cells are collected, they are processed and frozen in the laboratory and stored until it is time for your transplant.
Click to download and print Stem Cell Collection information: English • Spanish
Pre-Transplant chemotherapy
For some people, higher-dose chemotherapy can lead to longer remissions or sometimes even a cure. However, high-dose chemotherapy can cause your blood counts to remain low for longer periods of time.
In order to help the blood counts to recover faster after chemotherapy, we will collect your own stem cells before giving the chemotherapy and then will give the stem cells back to you after the chemotherapy is finished.
Most chemotherapy treatments take between one and five days. Depending on your health and the chemotherapy you receive, you may have to stay in the hospital.
After the chemotherapy is gone from your system, we will bring your stem cells from the laboratory, thaw them, and infuse them back into you.
What to expect during your transplant process
An IV catheter used during a stem cell transplant.
The bone marrow stem cells are infused through an IV catheter.
Nurses will stay with you during the stem cell infusion to check your vital signs and to make sure that you are comfortable. The stem cell infusion may take several hours or it may take less time. The length of your infusion depends on the total number of cells that need to be infused.
In order to protect your stem cells during the freezing process, a chemical called DMSO (Dimethyl Sulfoxide) is added to the stem cells at the time of collection. After your stem cells are reinfused, your body will get rid of DMSO through your breathing and through your urine. This will make your breath smell like garlic or creamed corn for several hours or even days. You might also notice a funny taste in your mouth, but this taste is not harmful. Lemon drops or hard candy might help you.
Frozen stem cells are removed from a storage container.
During your transfusion, bags of stem cells are thawed in a warm water bath minutes before they are transfused.
You might feel fever, chills, rash, or shortness of breath during infusion of your stem cells. The infusion may also cause nausea, headaches or, rarely, more serious reactions. We will give you medication to help prevent these symptoms, and extra treatments if necessary. You will be monitored closely during the entire infusion procedure.
Once the stem cells are infused, they will circulate in your bloodstream for a period of time and and, then eventually find their way back to your bone marrow to begin making blood cells again.
New blood cells will start forming in your bloodstream about 10-12 days after the stem cells infusion. This new blood cell growth is called “engraftment”.
The appearance of newly produced cells in the bloodstream is called engraftment.
Until your reinfused bone marrow produces enough new mature blood cells, you will have low blood counts including low white blood cells, low red blood cells, and low platelets. You might need to stay in the hospital if we think you may need a transfusion or if we need to watch you closely for infections. Our medical team will monitor you closely for any complications.
- We will check your blood counts daily.
- We will give you antibiotics to help prevent infections. The antibiotics that you receive will depend on your blood counts, how long it has been since your transplant, and whether any infections develop.
- If your red blood cells or platelets are low, we will give you transfusions.
One of the most important things you can do during your treatment is to walk every day. Getting out of bed and taking walks regularly — even while you are in the hospital — will help you to maintain your strength and stamina. Good strength and stamina speeds your long-term recovery.
Download and print Stem Cell Transplant information: English • Spanish
Recovery and long term follow up
Dr. Fero speaks with a patient during a visit.
It might take up to six months to fully recover your strength and stamina.
Your immune system will take time to recover. During the first year after your transplant, you will be in a higher risk for infections.
You might have to take some medication to prevent infections up to a year after transplant
After 6 months you should start to receive vaccinations and then boosters, similar to the types of vaccines normally given to children.
Once you have sufficiently recovered from your transplant, you can return to the care of your primary oncologists.
You and your transplant physician will review plans for your future care. We will also give you a summary of your treatment and contact information for your transplant team, in case you have questions later.
Your transplant team will be available for you for any transplant related questions or concerns. Please don’t hesitate to reach out to us.
Available Resources
For more information, check the following resources.
Learn more: In-depth from the National Cancer Institute
The content below is provided by the National Cancer Institute. Please contact the UNM Comprehensive Cancer Center at 505-272-4946 for more information.
The content below is provided by the National Cancer Institute. Please contact the UNM Comprehensive Cancer Center at 505-272-4946 for more information.
The content below is provided by the National Cancer Institute. Please contact the UNM Comprehensive Cancer Center at 505-272-4946 for more information.