Stem cell mobilisation and collection procedures using G-CSF

G-CSF mobilisation and peripheral blood stem cell harvesting

What are stem cells?

Stem cells are the seeds from which blood cells (red cells, white cells and platelets) grow. These can be found in the bone marrow or can be encouraged to enter the blood stream by the use of injections called ‘growth factors'.

Why do we collect stem cells?

A transplant may be a potential future treatment option for treating your blood disorder. This will involve your receiving large doses of chemotherapy and/or radiotherapy. Chemotherapy and radiotherapy destroys cancer cells. However, as a side effect they also destroy normal blood cells and a person's ability to produce new blood cells.

By taking your stem cells now and returning them to you after chemotherapy/radiotherapy, we can overcome some of these side effects, as these stem cells will seed and grow to produce new blood cells.

Do I need any tests prior to starting this treatment?

Yes. You will need some blood tests so that we can make sure that your body has completely recovered from any previous treatment. We also need to assess whether you have had any infections such as HIV, hepatitis, HTLV and syphilis before we are able to collect and store your stem cells. This is also a blood test. There is a counselling service available to you prior to having the blood test should you wish to use it. You will need to consent to this testing on the harvest consent form.

Please discuss this with the consultant or the transplant co-coordinator prior to the blood sample being taken.

How do we collect blood stem cells?

This is done in two stages:

First we have to 'mobilise' the stem cells. This means that we encourage them to come out of the bone marrow and enter the blood stream. We call this 'mobilisation'. This is achieved by giving you a growth factor called G-CSF. G-CSF is a small injection, which is given under the skin for four or five days. This can be self-administered or we can arrange for this to be administered on the haematology day unit Ward E10/or for children on PDU, at your local hospital, via community nurses, or at your GP surgery. When you have the injections we may monitor your blood count on the third day. This helps us assess how effective the injections have been so far. On the fifth day, you will attend the Apheresis Unit or PDU for children, for your stem cells to be collected. This is called 'harvesting'.

In order to collect the blood stem cells a needle is placed into a large vein in each of your arms. (We will assess your veins when you come for your outpatient appointment.) Children will usually have a CVC in place for this purpose. We then connect you to a cell separator machine. This machine spins the blood and separates it in to different parts. The machine can detect the cells that we wish to collect and put them into a bag. The rest will be returned to you.

How long will stem cell collection take?

The stem cell collection itself takes three to 5½ hours. We then calculate the numbers of cells we have collected. We aim to collect all we need in one harvest. If we do not have enough cells, we may give you another injection of G-CSF and attempt to collect more cells from you the following day. This could be done for three days in total if necessary.

Is it possible to collect blood stem cells in everyone?

No. Some people do not 'mobilise' blood stem cells. In cases where this occurs we would discuss with you alternative methods of collecting stem cells.

Are their any side effects of this treatment?

To prevent your blood from clotting whilst in the cell separator, an anticoagulant is added to it. This may cause tingling or pins and needles in your fingertips or around your mouth. If this happens make the nursing staff aware.

It is not unusual to get some mild to moderate aches and pains in the bones of your trunk and limbs after the G-CSF injections. Some people also experience a headache. Taking regular mild pain relief such as paracetamol can often relieve these pains. Your Haematology specialist nurse will be able to advise you what pain relief would be most appropriate to take. There is also a risk of very small blood vessels becoming blocked whilst you are receiving G-CSF if your white count is too high. We may monitor your blood count if appropriate to reduce the risk of this occurring.

Do I need to stay in hospital when the stem cells are collected?

No, you do not need to be admitted into hospital for the stem cell collection. This is an outpatient procedure.

Where will the stem cell collection take place?

Stem cell collection is done on the Apheresis Unit or on PDU for children at Addenbrooke’s hospital by nursing staff that have undergone special training.

Am I allowed to eat before the stem cell collection?

Yes, we would encourage you to eat a good meal before the collection.

Can I bring a friend/relative with me when the stem cells are harvested?

Yes, but just one other person, as the space in the day unit is limited. Parents can be with the child whilst being harvested on PDU.

How long will I need to take off work/school?

When you are receiving the daily GCSF injections you may need to have blood taken on day three. This can be done on ward E10, PDU or at your local hospital at the same time as the injection. The blood test needs to be taken in the morning. Once this is done, you will be able to go to work/school as usual. You will need to take the whole day off work/school on the day the collection is to take place. We also recommend that you make plans to have the following day(s) off just in case we need to do a further collection.

How long are the blood stem cells kept?

Once your stem cells have been collected they will be frozen until they are required. Most of the time we will be planning to use all the cells collected as part of the transplant however there may be cells which are stored. The harvest can be stored for several years at very low temperatures but it is impractical to keep cells indefinitely. With your permission your doctor will decide to dispose of the cells in the following circumstances:

• If you die
• If your disease progresses and/or it is clear that a transplant using your own cells is not in your best interests
• If your disease appears to be in remission and there is no necessity for a bone transplant. This period will not be less than six years.

If I do not need the cells could they be used for research?

Yes. However, to allow the haematology team to do this you will need to give us your permission on the harvest consent form. This form will be kept in your medical notes. The cells would only be used for research if they were to be otherwise destroyed.

Where the stored cells will not be used for treatment they may be used for research purposes rather than be discarded if your consent has been obtained in accordance with the requirements of the Human Tissue Act 2004.

Tissue from the living may be stored for use and/or used without consent, provided that:

• The research is ethically approved.
• The tissue is anonymised such that the researcher is not in possession of information identifying the person from whose body the material has come and is not likely to come into possession of that information.

Note: You will be asked to sign the harvest consent form before this process can go ahead.

This information has been designed to give you an overview of donating stem cells. If you have any additional questions, please do not hesitate to contact the bone marrow transplant nurse practitioner/coordinator.

Privacy & Dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.