We use certain drugs to increase the number of stem cells in the peripheral blood prior to collection for the transplant. This process is called mobilization. Two common methods of mobilization are colony stimulating factors (CSFs) and chemotherapy.
CSFs
CSFs are human proteins that are produced by the body to increase blood cell production. As the stem cells in the bone marrow begin producing more blood cells, increased numbers of stem cells are also produced and released into the blood stream. The most common side effects of CSF’s are mild-to-moderate bone pain or fever, which can often be controlled with Tylenol.
Allogeneic Patients
If you are receiving an allogeneic transplant, your donor may receive CSF’s to mobilize stem cells prior to collecting their peripheral blood stem cells. CSF’s are given to the donor by daily injections for a period of approximately 5 days. Your conditioning regimen will coincide with your donor’s mobilization and collection processes.
Autologous Patients
If you are receiving an autologous transplant, CSF’s are given by daily injections for approximately 5-10 days prior to stem cell collection. You may also receive a one time injection of a long acting CSF. Your nurse may teach you or your Caregiver how to inject this medication, or you may receive it in the clinic, depending on your comfort level as well as the wishes of your insurance company.
Chemotherapy
Mobilization chemotherapy is only used for autologous transplant patients. The chemotherapy used for mobilization varies depending on many factors including your disease and past treatments. Your transplant physician will make the appropriate recommendation as to which mobilization chemotherapy is best for you. Commonly used chemotherapy agents are cytoxan and etoposide either alone or in combination.
We expect your blood counts to drop for several days after you receive your chemotherapy. For this reason, we closely monitor your complete blood count (CBC) following the mobilization chemotherapy. To protect you during the time when your blood counts are low, an oral antibiotic will be prescribed.
The drop in your complete blood count is followed by a rapid rise in your white blood cell count, approximately 9 –11 days after receiving your mobilization chemotherapy. Your blood will be drawn in the infusion center as your white count rises to evaluate the number of circulating stem cells (CD34 cells). Once this number is equal to or greater than 10, you will begin stem cell collection (apheresis).