Autologous Bone Marrow Transplant: Step-by-Step Procedure and Patient Care

Autologous transplant uses the patient's own hematopoietic stem cells to rescue bone marrow after high-dose chemotherapy/radiation. It's standard for multiple myeloma, lymphoma, and select leukemias/autoimmune diseases.

Six Phases

1. Mobilization: G-CSF (filgrastim) ± plerixafor → stem cells egress from marrow to blood. Monitor CD34+ count.
2. Apheresis (collection): Leukapheresis over 1–5 days; target ≥2–5 × 10⁶ CD34+ cells/kg. Cryopreserved with DMSO.
3. Conditioning (high-dose chemo): e.g., Melphalan 200 mg/m² (myeloma), BEAM/BuCy (lymphoma). Eradicates residual disease and creates "space."
4. Stem cell infusion: Thawed cells infused IV (like blood transfusion). Dimethyl sulfoxide (DMSO) odor/taste; premeds for nausea.
5. Engraftment (days +10 to +28): Neutrophils >0.5 × 10⁹/L (first), then platelets >20 × 10⁹/L. Growth factors (G-CSF) often used.
6. Post-transplant care (months 1–12+):
   • Infection prophylaxis (antivirals, antifungals, PJP, IVIG).
   • GVHD rare (autologous) but possible (autoimmune flare).
   • Organ toxicity monitoring (veno-occlusive disease, cardiac, pulmonary).
   • Vaccination re-initiation (6–12 mo).
   • Surveillance for relapse, secondary malignancies.

Advantages Over Allogeneic

• No graft-versus-host disease (GVHD).
• No donor search; faster.
• Lower transplant-related mortality (1–2% vs. 15–20%).

Limitations

• No graft-versus-tumor effect.
• Risk of reinfusing malignant cells (purging techniques evolving).
• Age/organ function limits eligibility.

Autologous transplant is a curative-intent therapy for many hematologic malignancies, with evolving applications in autoimmune disease.