From start to finish, a stem cell transplant can take between one (outpatient) and six (inpatient) weeks to complete. It takes about six months to recover from an autologous transplant and one-to-two years to recover from an allogeneic transplant. In addition to making you aware of the time commitment required for the treatment and intensive recovery, your cancer team will ask you questions about your lifestyle to ensure you are adequately prepared for the months following the transplant. These questions may include, but are not limited to:
- Do you have a family, member, friend, or the means to hire a home nurse to provide care and transport you to daily follow-up appointments for up to 100 days as you recover from the transplant?
- Are you located within 30 miles of the transplant center, or are you able to acquire temporary housing near the center for up to 100 days after your treatment?
- Do you have any active mental health or substance abuse issues?
- Do you have health insurance?
- Do you need help applying for disability benefits while you are recovering from the procedure?
If your transplant will be autologous, your doctor will put you on a schedule to collect your stem cells in the weeks leading up to your transplant conditioning. To begin, you will be given an injection of growth factors, which stimulate the blood stem cells in the bone marrow to multiply and be released into the bloodstream. These injections may continue for up to six days (though five is typical), and side effects of them may include bone pain (most common), and flu-like symptoms, including fever, headaches and muscle pain. These are typically minor and subside after the injections are completed.
After the injections are completed, the stem cells are collected with a process known as apheresis. The blood is removed through a needle in one arm, then pumped through a machine that separates the blood-forming cells from the rest of the blood, which is returned to the body through another needle in the other arm. This collection process can take up to eight hours.
During this time, you will be placed in a comfortable reclining chair, where you can work, watch television, read, or even nap. Some centers will even allow you to bring a companion if you wish to have company (and if not, you can stay connected with video calls on your phone or computer). The process is often a comfortable one, with only mild side effects such as tingling skin and chills caused by the anticoagulant used in the apheresis process. You may want to be prepared that you will not be able to, generally, get up at all and will need to use a bedpan or possibly a bedside commode to relieve yourself during collection. You will have to keep your arms pretty much straight and still, so don’t plan to do a lot of arm-moving. Lastly, you may receive instruction to eat Tums or to try to get extra calcium to mitigate the side effects of that tingling; listen to what the transplant coordinator suggests!
Throughout the collection process, your nurse will come in to check your vitals and make sure you aren't reacting to the anti-coagulants. When the collection process is complete, the nurse will remove the needles in your arms. You may be asked to stay in the treatment room for up to 30 minutes after these needles are removed to ensure you do not have any adverse reactions to the medications used. You may also be given food and drink to avoid any lightheadedness.
After collection, the stem cells are taken to a processing laboratory, where they are prepared for freezing and storage in liquid nitrogen. This keeps the cells safe and stable until they are needed for transplantation.
The cycle of injections (one additional for each additional day collection is needed) and collections is continued until a sufficient number of stem cells are obtained to perform the transplant—usually no more than three days. If the transplant team can't get the cells they need after that, they may make a new plan for you, such as chemo, a clinical trial, or even an allogeneic transplant. Allogeneic donations follow this same protocol, and you will not need to be present for the donor’s apheresis procedures. Once your cancer treatment team has determined that enough stem cells are present, you will begin your transplant conditioning regimen.