High-dose Treatment Supported with Stem-cell Transfer

Some cancer diseases do not react as hoped to standard chemotherapies. In the case of some cancer types, the treatment results may improve when chemotherapy is administered in greater doses. In order to avoid side effects that are difficult to manage, such high-dose treatment is supported by autologous stem cell transfer. At Tays, the treatment is ensured by specialists in blood and cancer diseases.

Usually we use the high-dose chemotherapy, i.e. intensive therapy, to treat lymphomas and sometimes certain solid cancer types, such as testicular cancer and some rare cases of sarcoma. However, high-dose treatment cannot be provided alone, because it would cause side effects that are difficult to manage.

The treatment provided with the support of an autologous stem cell transfer means that blood-producing stem cells are collected from the patient him/herself. These are returned via an intravenous drip after the high-dose chemotherapy. The stem cells seek their way back into the bone marrow and restore its functioning.

Treatment negotiation

Before the treatment, we invite the patient to a treatment negotiation to discuss the impact and possible risk factors of the treatment. At the same time, we agree on the schedules in a preliminary manner. Close relatives and friends may also take part in the treatment negotiation. This may take place at the cancer outpatient clinic, if the rest of the treatment takes place at the patient’s own central hospital, or at ward at Tays, if the cancer treatment takes place there.

During the treatment negotiation, it is possible to ask the doctor and nurse about any unclear or troubling matters.

After the treatment decision, we plan a more precise and individual schedule in the weekly stem cell transfer meeting.

Intensive treatment at Tays

Phases of intensive treatment:

  • chemotherapies of cancer
  • response examinations
  • chemotherapy and white cell growth substance therapy adding stem cells into the circulation
  • stem cell collection
  • continuation of chemotherapies according to need
  • high-dose chemotherapy and return of stem cells.

The intensive treatment comprises response examinations, treatment adding stem cells to the circulation and stem cell collection, high-dose chemotherapy and the return of the stem cells.

Response examinations

Response examinations are used to assess the impact of previous treatments on the disease before the final stem cell transfer decision. If the manifestations caused by the disease are found to have disappeared completely, intensive treatment can be recommended to the patient.

If the manifestations caused by the disease are still present, the situation must be assessed, and usually the patient benefits from further treatments before the intensive treatment.

Stem cell-adding treatment

Stem cells are cells produced by the bone marrow and all other blood cells develop from them. Normally, they are very scarce in the circulation.

For collection, the number of stem cells must be temporarily increased by administering quite a large dose of cytostatics to the patient. This hospital stage usually lasts 3–5 days at ward.

This is also supported by subcutaneous injection of growth substances.

These procedures make the stem cells leave bone marrow and enter the circulation. The stem cells are then collected from the circulation with the help of a cell separation device. The stem cells are kept frozen in a laboratory until the patient gets them back after the high-dose chemotherapy to be given later.

Stem cell collection

The patient returns to the hospital one week after the stem cell-adding treatment. During this stay, the patient is fitted with a central vein cannula inserted into the subclavian vein. The preparations for the fitting of the cannula is done at the ward and the procedure itself is done by an anaesthetist in an operating theatre.

Laboratory samples are taken from the patient in the mornings. They are used to determine when the collection of the stem cells may begin.

The collection takes place at ward 10a with a device developed for this purpose. The machine separates the stem cells from the blood and returns all other cells back into the circulation. The procedure takes 4–5 hours and is usually performed on 2–3 successive days.

When it has been ensured that a sufficient amount of stem cells has been collected, the central vein cannula is removed and the patient discharged. The hospitalisation lasts in total 5–7 days.

High-dose treatment and return of the stem cells

On the day following admittance to the hospital, the patient is fitted with a central vein cannula in an operating theatre. When the patient has been given the high-dose chemotherapy, the previously collected stem cells are returned via the cannula by drip, once the cytostatics have disappeared from the blood, i.e. usually 72 hours after the end of therapy.

After the intensive treatment, the recovery of the cells usually lasts 2–3 weeks. Blood cells are at their lowest 7–10 days after the beginning of chemotherapy. At that time, the patient is more vulnerable to inflammation and needs different treatments that support recovery, such as transfers of red blood cells and blood platelets, intravenously administered antibiotics and nutrient solutions.

Recovery at the ward and follow-up monitoring

The effects of the treatment are more difficult than those of normal chemotherapy. Usually, recovery at the cancer ward lasts 3½ weeks.

During the stem cell transfer stay, the patient stays in a single room with an en suite toilet and shower. Visitors may come to see the patient, but may not have any infectious diseases.

We implement the treatment in cooperation between many experts. The patient’s personal doctor is a ward doctor specialising in blood or cancer diseases. If the patient so wishes, he/she can also be assigned a personal nurse, who cares for the patient during his/her shift.

Follow-up monitoring takes place at the patient’s own central hospital. We also process the monitoring data at the stem cell transfer meeting of Tays after one, three, six and twelve months and two and three years of the treatment.

Persons in charge

Specialist Leena Keskinen
Chief Physician Tuula Lehtinen