Self (autologous) stem cell transplants

Stem cell transplants that use your own stem cells are called autologous stem cell transplants. Autologous stem cell transplants are sometimes used in the treatment of lymphoma to replace damaged or destroyed stem cells with healthy ones.

We have separate information on stem cell transplants using stem cells from a donor (allogeneic stem cell transplants).

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What is a self (autologous) stem cell transplant?

Who might have one?

What does it involve?

What are the risks?

Follow-up

Recovery

What is a self (autologous) stem cell transplant?

A stem cell transplant is a procedure that replaces damaged or destroyed stem cells (cells in your bone marrow that make new blood cells) with healthy stem cells. 

‘Autologous’ means something that comes from you, as opposed to something that comes from someone else. In this case, your own stem cells are collected and frozen to be given back to you as part of the transplant process.

You might also hear an autologous stem cell transplant referred to as an ‘autograft’.

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Who might have an autologous stem cell transplant?

You might have a stem cell transplant if you need high-dose anti-cancer treatment. High-dose treatment aims to destroy lymphoma cells but it can also destroy your stem cells. This stops you from making the new blood cells your body needs. A stem cell transplant allows you to have high-dose treatment because it replaces the stem cells damaged by the treatment.

High-dose treatment with an autologous stem cell transplant is used in certain circumstances with the aim of curing your lymphoma or making your remission from lymphoma last longer than it would otherwise. Most people with lymphoma do not need a stem cell transplant. 

A stem cell transplant is an intensive form of treatment and you have to be well enough to have one. It can take many months to fully recover. Your medical team consider many factors before recommending a stem cell transplant. 

Below we list some of the situations when an autologous stem cell transplant might be recommended. Not everybody with these types of lymphoma needs a stem cell transplant – and there might be other situations where your medical team feel a stem cell transplant is the best option for you.

You might have an autologous stem cell transplant:

• If you respond to initial treatment but your lymphoma comes back (relapses), especially if it comes back very quickly. This option might be suggested if you have Hodgkin lymphoma, follicular lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma, primary central nervous system lymphoma or Waldenström’s macroglobulinaemia.
• If your lymphoma doesn’t respond to your first treatment (refractory), particularly if you have Hodgkin lymphoma, DLBCL or Waldenström’s macroglobulinaemia.
• As part of your first treatment if you have a type of lymphoma with a high risk of relapse (for example, fast-growing mantle cell lymphoma or primary central nervous system lymphoma) or other factors that suggest you might be at high risk of relapse.

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What does an autologous stem cell transplant involve?

There are a number of steps involved in an autologous stem cell transplant:

• you have tests and scans to make sure you are well enough to have the treatment
• your own, healthy stem cells are collected from your blood and stored
• you have high-dose anti-cancer treatment in hospital (this is also called ‘conditioning treatment’)
• your stored stem cells are given back to you to replace the stem cells that have been destroyed by the high-dose anti-cancer treatment
• you stay in hospital while your blood counts to recover.

We have detailed information about each step on our page on having a stem cell transplant.

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What are the risks of an autologous stem cell transplant?

The most serious risks of autologous stem cell transplants are:

• a high risk of infection
• side effects of your high-dose anti-cancer treatment
• rarely, graft failure.

You are also at risk of developing late effects (health problems that may develop months or years after your treatment).

Risk of infection

After an autologous stem cell transplant, you have very low blood counts for a few weeks. Having a low white blood cell count, especially a type of blood cell called ‘neutrophils’ (neutropenia), puts you at very high risk of developing an infection. Your blood counts start to rise after a few weeks but it can take many months for your immune system to fully recover.

While you are in hospital, your medical team take precautions to reduce your risk of infection. They also monitor you closely for any signs of infection. Although taking precautions can reduce your risk of infection, you cannot avoid all sources of infection. Infections can be treated, particularly if they are caught early.

When you go home, your medical team should tell you what signs to look out for and who to contact if you are worried you might have an infection.

Contact your medical team immediately if you have any signs of infection.

Side effects of conditioning treatment

You are likely to experience side effects from your high-dose anti-cancer treatment (‘conditioning’ treatment). We have separate information on the most common side effects of lymphoma treatments, including practical tips on how to cope with them. You might find the following pages particularly helpful:

• anaemia (low red blood cell count)
• bowel problems (diarrhoea, constipation, wind)
• dry, sore mouth (oral mucositis)
• sickness (nausea and vomiting)
• thrombocytopenia (low platelet level).

Graft failure

Graft failure occurs if the transplanted stem cells fail to settle in your bone marrow and make new blood cells. This means your blood counts do not recover. 

Graft failure is serious but it is very rare after an autologous stem cell transplant. Your medical team monitors your blood counts closely. If your graft does fail, you might be treated initially with growth factors or hormones. These encourage the stem cells in your bone marrow to produce more cells. You might need a second stem cell transplant.

Late effects

Late effects are health problems that may develop months or years after your lymphoma treatment. Most transplant centres have dedicated late effects services that offer screening programmes to detect late effects as early as possible. This gives you the best chance of being treated successfully if you develop any late effects.

Your medical team should tell you what late effects you might be at risk of and what you can do to reduce your risk of developing them. 

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Follow-up after an autologous stem cell transplant

Most people go home 2 to 3 weeks after having their stem cell transplant. However, it can be longer, particularly if you develop a serious infection or other complications. Your risk of complications is highest in the first few weeks after your transplant but it can take many months for your blood counts to build up to normal levels. 

I had been in isolation through all this treatment and couldn’t wait to get home. As I live on my own, I organised for someone to come and stay with me for three weeks when I went home. I don’t think I would have been discharged without this in place and wouldn’t have been able to cope without it.

Penny, who had an autologous stem cell transplant as part of her treatment for CNS lymphoma

After you go home, you usually have appointments every week at first to check your blood counts are recovering well. You might need blood transfusions if they are low.

You then have appointments each month. Around 3 months after your transplant you are likely to have a CT scan or PET/CT scan to see how the lymphoma has responded to the treatment. If you had lymphoma in your bone marrow, you might also have a bone marrow biopsy.

You have regular tests to check on your recovery. Gradually, you have longer between your follow-up appointments. Your follow-up appointments are to check that your lymphoma has not come back (relapsed) and to look out for late effects (side effects that develop months or years after treatment). They are also an opportunity to ask any questions you might have.

When you have a stem cell transplant, you lose your immunity to diseases you were vaccinated against before your transplant. This includes the vaccinations you had as a child. Around 6 months to a year after your transplant, you might be offered a revaccination programme. You should also have any recommended annual vaccinations such as the flu and COVID vaccines.

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Recovery after an autologous stem cell transplant

It takes 3 to 6 months for you to recover completely. This can be a difficult time physically and emotionally. You might find our information on living with and beyond lymphoma helpful. 

It was a good six months after I finished treatment until I went back to work on a phased return. It was difficult getting back into working life.

Matt, who had an autologous stem cell transplant as part of his treatment for non-Hodgkin lymphoma

When you first go home, your blood counts are likely to be low. Follow any precautions your medical team recommend to help you stay well.

• Make sure you know how to reduce your risk of getting an infection and what signs to look out for. Your medical team should give you numbers to call at any time of day if you are worried.
• If you have low platelet levels (thrombocytopenia), you are at increased risk of bruising and bleeding. Take precautions to avoid injuring yourself and contact your medical team if you have any signs of bleeding.

During this time, you are also likely to be experiencing side effects from your high-dose treatment. You might feel unwell and very tired. Give yourself time to recover. Many people feel well enough to return to work between 3 and 6 months after their transplant. You may find it helpful to start with shorter days or weeks and gradually build them up as you feel able to.

Your medical team should advise you on other factors to consider during your recovery. 

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