Steps of an Autologous Stem Cell Transplant

There are eight major steps involved in getting a transplant.   

Step 1: Know if a transplant is right for you and prepare for the transplant

Your cancer and overall health are checked to see if an autologous stem cell transplant is the right treatment for you. You will need to do some basic tests and procedures as part of this assessment. Your health care team needs to know if your cancer is under control, how much of it is still there, and if your body can handle the transplant.  

Your health care team at LHSC’s Verspeeten Family Cancer Centre includes:  

• Hematologists/oncologists  
• Transplant doctors  
• Nurse practitioners  
• Specialized transplant clinic, apheresis and inpatient nurses  
• Social workers  
• Administrative assistants  
• Doctors in training (called residents or fellows)  
• Physiotherapist  
• Occupational therapist  
• Dietitian  

Your initial consultation with the transplant doctor is the beginning of step one. This is when you are given this information.  

Step 2: Stem cell mobilization

You will need treatment to move your stem cells from your bone marrow into your bloodstream – this process is called “stem cell mobilization.”  

Step 3: Get a central intravenous (IV) line put in 

About one (1) to four (4) days before getting your stem cells collected, you will need a central IV line. You will get either a PermCath or Hickman line. These are special IV lines that are put into one of the large veins under the collarbone in your neck. You will be given some light sedation during this appointment so you will need someone to drive you home.  

If you are not having your stem cell transplant right away after collection, sometimes veins in your arm can be used if the apheresis nurses feel they will work well.  

Step 4: Collect your stem cells 

Your stem cells will be collected by a process called “apheresis.” During this process:  

• Your blood is run through an IV line into the apheresis machine where the stem cells are removed from your blood and collected. The rest of your blood is then returned to your bloodstream.  
• The apheresis machine is similar to the machine used by patients with kidney disease who have their blood cleaned by dialysis. Once the stem cells are collected by apheresis, they are cryopreserved (frozen) until you are ready for the transplant.   

Step 5: Get your high dose chemotherapy 

Approximately one (1) to three (3) weeks after your stem cells are collected you will be scheduled to get high dose chemotherapy to destroy your cancer and bone marrow.  

• This chemotherapy may be given as a dose on one day or in many doses over several days, depending on your type of cancer and what your health care team decides.  
• You will be given extra medications to help prevent nausea and vomiting from the chemotherapy.  
• You may also be given IV fluids to help flush the chemotherapy out of your system.  
• You will get the chemotherapy either as an outpatient or an inpatient. This is given on the seventh floor of C building (C7) at Victoria Hospital  

Step 6: Infuse stem cells – Get your stem cell transplant

After getting your high dose chemotherapy, you will need to wait one to two days before having your stem cells infused into your bloodstream. You will receive your reinfusion and ongoing care as either an inpatient or an outpatient. You and your transplant physician will determine what option is most appropriate for you.    

This stem cell infusion is the actual “stem cell transplant” part of your treatment.  

By waiting at least one to two days after the chemotherapy, your body will have time to flush out the chemotherapy drugs before infusion the stem cells into your bloodstream.  

The stem cells are thawed at your bedside and infused through your central line, very much like a blood transfusion.  

If you receive your reinfusion as an inpatient, you will be admitted to the C7 Inpatient Unit for the reinfusion and ongoing care until you are ready for discharge.  

If you receive your reinfusion as an outpatient, your reinfusion will be done in the C7 Day Hospital. Starting the day after your reinfusion, you and your caregiver will come every day to the C7 day Hospital to be seen by a member of the transplant team until discharge from the Blood and Marrow Transplant Program.  Care outside of your daily visits to the hospital will be provided in your home, or at the Residence Inn, by your caregiver.  

You will only be admitted to hospital if a health care provider’s assessment determines you are unsafe to stay in your home setting and require admission for closer monitoring and/or support.   

Step 7: During your transplant 

During your transplant, you will be assessed each day by the nurses, nurse practitioners and/or doctors. They will assess your blood levels, what side effects you may be feeling and whether you need any:  

• Transfusions  
• Replacement of any fluids and electrolytes (minerals) your body needs  
• Antibiotics (medicine that fights infection)  
• Tests to check for infections  

You will be cared for in the hospital for about two (2) to three (3) weeks if you receive an inpatient transplant. You will have daily visits to the C7 Day Hospital for two to three weeks if you receive an outpatient transplant.

During your transplant you can rest or sleep, have visitors, go for walks and do other activities, such as reading, watching videos, play games.

You will be discharged approximately two to three weeks after your stem cell transplant once your blood counts have started to recover.

If you are discharged around two weeks you will come back in the first week to the C7 Day Hospital for several visits with the nurse practitioner to follow your progress. 

If you:  

• have been referred by the Windsor Regional Cancer Centre Oncology team, and/or  
• reside in the Erie St. Clair Local Health Integration Network (LHIN)

You may be transferred to Windsor Metropolitan Hospital for part of your transplant care.

If this is planned, you will be notified prior to your admission for transplant. 
Transfer to Windsor Metropolitan is arranged by the Verspeeten Family Cancer Centre transplant team.

Transfer is planned for the day after your stem cells are infused.

You will be transferred in a medical transport van on a stretcher. We arrange pick up at the cancer centre for around 10:00 a.m. You will have your immediate post-transplant care provided in Windsor by the Windsor transplant team.

If you are transferred to Windsor, your follow-up care after discharge will depend on where your hematologist/oncologist works.

If your hematologist/oncologist works in:  

• Windsor - you will not need to follow up in London but will continue to follow with the Windsor transplant team. 
• London - you will have a post discharge follow up with the London transplant team.

If you are staying with the Verspeeten transplant team, you will then be referred back to the Verspeeten outpatient area. At that visit, your health care team will monitor your blood counts to ensure they are getting better.

Your transplant doctor or nurse practitioner will talk about plans for your ongoing care in the outpatient clinic.

Once these early issues are taken care of, you will be seen by your hematologist/oncologist in your usual clinic.