Review the steps involved in getting your stem cells mobilized, central IV line inserted, and stem cells collected.
Steps:
- Stem Cell Mobilization
- Central Venous Catheter Insertion
- Apheresis (Stem Cell Collection)
Step 1: Stem Cell Mobilization
Stem cell mobilization is the process of moving your stem cells from your bone marrow into your bloodstream. The stem cells can then be collected from your blood and used for your stem cell transplant. Your stem cells will be given back after getting high dose chemotherapy to speed up the recovery of your blood counts.
During mobilization and collection, you will keep taking your normal medications to deal with other health issues, such as medications for:
- High Blood Pressure
- Diabetes
- Cholesterol
- Pain
You will need to stop medications that are treating your cancer, (such as chemotherapy) approximately two weeks before your stem cell collection. However, you may be asked to continue with medications to prevent infection with viruses or bacteria (antivirals and antibiotics) that you were taking during chemotherapy.
Your Verspeeten team will tell you if, and when, you need to restart any medications. They will also let your oncology health care team know what instructions you were given.
Filgrastim
This is a medication that helps move stem cells out of the bone marrow and into the bloodstream. Filgrastim is given by a needle under the skin.
You will need to get the needle (one or two injections) every day for four days leading up to the stem cell collection date. It should be given about the same time each day.
Your transplant team will give you a schedule to help assist and remind you when to begin your Filgrastim injections. They will also set up home care to arrange for the injections.
You will need to pick up this prescription medication at the Verspeeten Family Cancer Centre pharmacy or the Windsor Cancer Centre pharmacy. It needs to be refrigerated, and you will be given a cooler bag with a cold pack. Bring this medication in the cooler to any appointments for these injections.
Taking Filgrastim injections
Once you start taking your Filgrastim injections, you will need to take them every day until you finish your stem cell collection. Your health care team will let you know what day to start.
What are the possible side effects of taking Filgrastim injections?
- Bone pain, especially in the lower back, legs, or even the breastbone.
- Headaches
- Fatigue
- Flu-like symptoms, such as muscle aches or soreness, or mild fever up to 380C
- Red or irritated skin where the needle was injected.
If you are having trouble with any side effects, contact your transplant nurse/home care nurse or call Verspeeten Telephone Triage at 519-685-8600.
If it is after-hours, a weekend or a statutory holiday, call CAREChart@home after-hours nursing line at 1-877-681-3057.
These side effects should stop a few days after you stop taking the Filgrastim injections. If you still have side effects a week or more after you stop taking the injections, tell your nurse.
Where should I keep my Filgrastim injections?
Always store the injections in the fridge until just before you use them.
I have to start taking Filgrastim injections soon, but the community health care provider has not contacted me yet. What should I do?
Community health care programs may not contact you until shortly before you start Filgrastim. If it is two days before your Filgrastim start date and you have not heard from them, please contact:
- Verspeeten Telephone Triage via telephone at 519-685-8600; or
- South West LHIN via telephone at 1-800-811-5146 or
- Erie St. Clair LHIN via telephone at 1-888-447-4468
While you are getting your mobilization, go to the hospital emergency department if you have:
- Shortness of breath that starts suddenly
- Blood in your urine or pain with passing urine
- Fever 38 degrees Celsius or higher
- Chills or shakes
- Severe bone pain that pain medication does not help
Step 2: Central Venous Catheter (IV line) Insertion
One (1) to four (4) days before stem cell collection, a central line, called a PermCath or Hickman, will be arranged to be inserted by the Interventional Radiology department. You will get some local freezing as well as some light sedation for this procedure. This central line will be used for your stem cell collection and will also be used for duration of your transplant.
You will need someone to drive you since you will not be able to drive home after the procedure.
Until the transplant, the PermCath or Hickman line will need to have dressings weekly. This may be done in your home.
Before transplant we advise that flushing is not to be done by community nurses, except for community dialysis nurses. You may need to come to LHSC or the Windsor Cancer Program weekly for flushing by trained nurses.
Step 3: Apheresis (stem cell collection)
After four days of injections, if the stem cell count in your blood stream is high enough, the stem cell collection will begin. This procedure is done in the Apheresis Department of the Dialysis Unit at Victoria Hospital.
It usually takes one (1) to three (3) days to collect enough stem cells. This depends on:
- How many stem cells are needed.
- The number of these cells that can be counted in your blood on the day of collection.
You need to make sure you can come for all the possible collection days. Each day, the nurses in the apheresis unit will let you know if you need to come back for another collection, or if the collection is completed.
Your health care team may adjust your medications during collection. This includes adjusting blood thinner medications (e.g., Apixaban; Aspirin; Edoxaban; Warfarin or Coumadin®; or Fragmin®) that helps prevent any bleeding issues during stem collection. It’s important that your team knows if you are on any of these medications.
What to bring with you:
- Any extra Filgrastim® injections.
- Health card
- Any meds you need to take that day
- Your pre-transplant binder and green folder
- Family member or friend for support. They may have to stay in the waiting room.
- Snacks and drinks
- Headphones with small circular jack for TV
- Tablet, e-reader (Wi-Fi is available)
- Please ensure that you wear comfortable clothing that is easily removed on the bottom in the event you need to go to the bathroom at the bedside
The day of collection
Go to apheresis unit: Victoria Hospital, A2-319. You will have been given a tour at your pre-transplant appointment, so you know where to go. You can also find tour videos on how to get to your appointment on the "How to get to stem cell appointments" page.
Arrive at 7:30 a.m. You will be checked for the number of stem cells in your blood. This will let the health care team know if you are ready to start the collection.
If your stem cell counts are not high enough in your blood:
- You will not have your stem cells collected that day
- You will be asked to return in the afternoon to be given a Filgrastim injection
- There is also possibility you will need a booster medication called Mozobil®, (plerixafor) which will be given on C7 at 9:00 p.m. that same night. Your apheresis nurse will let you know if you need this and where to go.
- You will need to return the next day at 7:30 a.m. to check your stem cell count again.
If your stem cell counts are high enough, stem cell collection can begin.
These are potentially long days, and if you live out of town, it may be advisable to plan to stay the night prior and the night of collection.
We can arrange accommodations at the Residence Inn for patients who live more than 100 kilometres (or one hour) away. Our stem cell transplant clerk will arrange this on your behalf.
Getting your stem cells collected
- You will be hooked up to an apheresis machine by your central line, if you have one, or by intravenous in your arms.
- Your blood will be drawn into the machine through one IV line.
- The machine will collect the stem cells from your blood and return the rest back to your body, through the other IV line
- The process of stem cell collection will take 6 - 8 hours each day.
Are there any side effects to the stem cell collection?
During collection, you may feel:
- Lightheaded or dizzy: This is due to your blood going through the machine. Let the nurse know if you feel this side effect.
- Cold: This is due to your blood going through the machine. It is normal and will stop when the collection is done. Ask the nurse for a blanket or dress warmly the day of your stem cell collection.
- Tingling in your lips, fingers and toes, and cramping in your hands and feet: This is due to low calcium from the anticoagulant medication used to prevent blood clotting inside the collection machine. Tell the nurse if you feel these side effects. Calcium will be added to your IV line and the symptoms should fade.
What if there are not enough stem cells?
Sometimes not enough stem cells can be collected. Your doctor or nurse will let you know if this happens and what your options are.
Some patients will need to get another medication call Mozobil® (plerixafor). This medication helps to release stem cells from the bone marrow into your bloodstream. It is given by injection. It is best given about 11 hours before your next stem cell collection, usually at 9:00 p.m.
If this medication is needed for your stem cell collection, the apheresis nurse will let you know and tell you where to go.
What are the possible side effects of Mozobil®?
- Feeling dizzy. Rise slowly over several minutes from sitting or lying position. Be careful climbing.
- Feeling tired or weak
- Headache
- Short-term discomfort at the injection site
- Nausea or vomiting. (Small frequent meals, frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.)
- Diarrhea
- Joint pain
What happens to the stem cells after they are collected?
After each stem cell collection, the bag of stem cells is taken to the lab and tested to count the number of cells. The bags are labelled, a preservative is added and then frozen until they are needed for your transplant.
Once your stem cells have been collected and frozen, the next step is preparing to come to hospital for treatment and transplant.
