ABOUT Hematopoietic stem cell transplantation (HSCT)
Hematopoietic stem cell transplantation (HSCT) involves the intravenous (IV) infusion of autologous stem cells to re-establish hematopoietic function in patients whose bone marrow or immune system is damaged or defective.
There are three kinds of bone marrow transplants, the type I will be having is Autologous. The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy treatment for 4 days. The stem cells are stored in a freezer (cryopreservation). Your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant and essentially Re -Boots the Immune System.
In Russia it would be Non-myeloablative chemotherapy. Non- Myelo is a reduced intensity treatment, also called a mini transplant.
Maximum pre-treatment exam duration = 1 week.
For approximately four days (twice a day), I will be given injections to stimulate my stem cell growth. The process of causing greater numbers of stem cells to be present in the blood stream in order for collection, is known as mobilization. The most common side effect of the mobilization process is mild-to-moderate bone pain or fever, which can often be controlled with Tylenol.
Apheresis (Collection of Stem Cells)
Apheresis is normally a painless procedure, however, back and hip pain have been reported. The collection of stem cells takes approximately two to four hours for the procedure. My blood will be withdrawn through a catheter and circulated through a cell-separating machine. This machine separates and collects white blood cells, including the stem cells, along with a few red blood cells and platelets. The remaining blood cells will be returned to my body. There is only a small amount (several cups) of your blood in the separator machine at any one time. Your blood is returned to you at the same rate it is removed. After the cells are collected, they are frozen and stored under special conditions until they are needed for my transplant.
Approximately four days of chemotherapy will be utilized to wipe out my existing immune system. Bloodwork will determine when the immune system has been sufficiently “shut down” in preparation for the stem cell transplant. At this point, the status of my isolation will be raised and only doctors and nurses will be permitted to enter my room.
Stem Cell Transplant
After the high-dose chemotherapy is completed, my own stem cells will be given back to me. There are few side effects to this procedure. It is very much like a blood transfusion. You may notice some chilling, nausea, fever, cough, flushing, headache, abdominal cramps or diarrhea. The nurses will give me medication to decrease these effects.
Although a stem cell transplant sounds dramatic, the actual procedure is simple. The stored frozen cells will be thawed in warm water, and infused back into my body.
One to three weeks following my transplant, signs that my stem cells/new immune system are growing (engrafting) and beginning to produce blood cells are expected. This “new” immune system will have no memory of MS. As this starts to occur, I may notice aching in my bones, especially my pelvis, lower back and thighs. As my blood counts begin to rise, my white blood cells will start to fight and prevent infections. Soon after this occurs, I will be released from the hospital.
It takes an average of 12-18 months to see the complete benefits of this treatment, however, some patients have continued to see improvement for up to five years post-transplant. In addition to halting the progression and activity of their MS, 80% of HSCT patients see a reversal of 45-80% of their pre-existing symptoms.