Always follow the advice of your care team.
Peripheral Blood Stem Cell (PBSC) Apheresis
Peripheral blood stem cell (PBSC) apheresis is a method of collecting stem cells from the peripheral (or circulating) blood using a cell separator. Blood is taken out of your body, moved through the cell separator to collect the stem cells, and then moved back into your body. This procedure is performed on an outpatient basis in the Kraft Family Blood Donor Center at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, which is located on the first floor of the Jimmy Fund building.
This video provides an overview of the peripheral blood stem cell collection process for autologous stem cell transplant patients.
Filgrastim and Plerixafor before PBSC Apheresis
Because the concentration of stem cells in your blood is relatively low, we will use a growth factor drug called granulocyte colony stimulating factor (G-CSF) also known as filgrastim (other brand names include Granix, Zarxio or Nivestym) to stimulate or “mobilize” your bone marrow. It works by increasing the production of white blood cells and hematopoietic stem cells (HSC).
Filgrastim is given by injection under the skin (subcutaneous) once a day for several days before blood stem cell collection starts and continues daily until stem cell collection is complete. This video shows you how to give yourself the growth factor injections that help increase stem cell production in your bone marrow.
Because the concentration of stem cells in your blood is relatively low, we will use a growth factor drug called granulocyte colony stimulating factor (G-CSF) also known as filgrastim (other brand names include Granix, Zarxio or Nivestym) to stimulate or “mobilize” your bone marrow. It works by increasing the production of white blood cells and hematopoietic stem cells (HSC).
Filgrastim is given by injection under the skin (subcutaneous) once a day for several days before blood stem cell collection starts and continues daily until stem cell collection is complete. This video shows you how to give yourself the growth factor injections that help increase stem cell production in your bone marrow.
Side effects of filgrastim can include:
Plerixafor, also known as Mozobil®, may be used in combination with filgrastim. Plerixafor helps release stem cells from the bone marrow so they can move into the bloodstream. If needed, plerixafor is given by injection the evening prior to starting the collection and for up to 3 additional doses. Side effects of plerixafor can include:
Another way of mobilizing stem cells is to provide the filgrastim after a large dose of chemotherapy. The stem cells increase in the blood in the recovery phase of chemotherapy and allow more efficient collection by apheresis. Your care team will determine which method of mobilization is best for you.
Preparing for Your Peripheral Blood Stem Cell (PBSC) Collection
Follow these guidelines as you prepare for your blood stem cell collection:
Special Medication Considerations
Take all of your medications as usual, unless you have high blood pressure and take an ACE inhibitor (like lisinopril or other medications ending in “-pril”). If this is the case, STOP taking the ACE inhibitor 24 hours before the start of the stem cell collection and until you have completed the collection process.
Additionally, if you are having a central line catheter placed for this procedure, there may be additional restrictions on your medications. Please speak with your care team.
If you are taking anticoagulation medication, check with your physician if you should discontinue their use prior to, or at any time during the collection process.
Day of Blood Stem Cell Harvest
On the day of your stem cell collection:
How Long Does a Blood Stem Cell Harvest Take?
Typically, apheresis collection lasts five to seven hours each day, for a period lasting from one to three days. The apheresis procedure may cause certain side effects including:
Be sure to let your apheresis nurse know if you are experiencing any of these symptoms during collection.
Although the procedure is well tolerated, most people are very tired at the end of the collection. This fatigue can last up to a week in some cases.
The Kraft Family Blood Donor Center offers individual DVD players and a movie library that you can use during the collection process.
The Recovery Period after PBSC Apheresis
The recovery period for peripheral blood stem cell collection varies from person to person. You may experience fatigue and discomfort for a short period. Fatigue may last for up to a week after the procedure. If you feel worsening pain and discomfort at any time after the collection, contact your care team.
Please refer to the comprehensive guide - Stem Cell Transplantation: An Information Guide for Patients and Caregivers for more information.
- Headache
- Bone and muscle ache
- Fatigue
- Rash
- Nausea/vomiting
- Diarrhea
- Other flu-like symptoms
Plerixafor, also known as Mozobil®, may be used in combination with filgrastim. Plerixafor helps release stem cells from the bone marrow so they can move into the bloodstream. If needed, plerixafor is given by injection the evening prior to starting the collection and for up to 3 additional doses. Side effects of plerixafor can include:
- Diarrhea
- Bloating
- Flu-like symptoms
- Lightheadedness
Another way of mobilizing stem cells is to provide the filgrastim after a large dose of chemotherapy. The stem cells increase in the blood in the recovery phase of chemotherapy and allow more efficient collection by apheresis. Your care team will determine which method of mobilization is best for you.
Preparing for Your Peripheral Blood Stem Cell (PBSC) Collection
Follow these guidelines as you prepare for your blood stem cell collection:
- Eat a healthy diet.
- Get plenty of rest, preferably 7-8 hours of sleep per night
- Avoid alcoholic beverages for two weeks before stem cell collection begins. Alcohol can dehydrate you and interfere with cell collection.
- Drink plenty of fluids. Begin drinking extra fluids one week prior to collection. This helps open your veins for the collection process.
- Do not take any anti-inflammatory medications (such as aspirin, Motrin®, Advil®, Aleve®, or arthritis medications) within 48 hours before apheresis. These can interfere with normal clotting of your blood and put you at risk for bleeding. If you have any discomfort or pain, take acetaminophen (such as Tylenol®, max 3g/day) only if approved by your care team. Speak with your care team if this is not effective.
- Two weeks prior to the donation, stop taking all aspirin and aspirin-containing products such as Excedrin® and Alka Seltzer®. Be sure to check with your doctor that stopping aspirin is appropriate.
- Check with your care team about other medications you take.
Special Medication Considerations
Take all of your medications as usual, unless you have high blood pressure and take an ACE inhibitor (like lisinopril or other medications ending in “-pril”). If this is the case, STOP taking the ACE inhibitor 24 hours before the start of the stem cell collection and until you have completed the collection process.
Additionally, if you are having a central line catheter placed for this procedure, there may be additional restrictions on your medications. Please speak with your care team.
If you are taking anticoagulation medication, check with your physician if you should discontinue their use prior to, or at any time during the collection process.
Day of Blood Stem Cell Harvest
On the day of your stem cell collection:
- Eat breakfast before you come to the Kraft Family Blood Donor Center.
- If you are having your central line catheter placed that morning, follow instructions given to you by the team placing the catheter.
- If you have diabetes (type 1 or 2), eat a low carbohydrate breakfast prior to stem cell collection. The daily requirement to start collection is a random or fasting serum glucose <180
- If you have difficulty managing hyperglycemia, or presented previously with serum glucose >250, your care team may advise you to not have breakfast prior to the start of collection. In such cases, once it is confirmed that your glucose level is <180, breakfast will be provided. You are encouraged to bring blood sugar monitoring/testing supplies and insulin.
- Do not drink caffeinated beverages such as coffee, tea, or cola (or other soft drinks) because they act as diuretics, which increase urination and can make you dehydrated which can affect your blood volume. You may request these beverages once your collection has started.
- Follow your care team’s instructions on what specific medications you may need to withhold on the day of collection.
- Wear comfortable loose-fitting clothes. If you have a central venous catheter in place, wear a shirt that buttons in the front to allow easy access.
- Bring your license or other photo identification.
How Long Does a Blood Stem Cell Harvest Take?
Typically, apheresis collection lasts five to seven hours each day, for a period lasting from one to three days. The apheresis procedure may cause certain side effects including:
- Lightheadedness or dizziness
- Tingling of your lips and fingers
- Cramps in your hands, legs or feet
- A sensation of feeling faint or mild chest tightness
- Low blood pressure, high blood pressure, or a slow or rapid heart rate.
- Bruising or infection may occur at the sites where the needles enter your veins (if a central catheter is not being used).
Be sure to let your apheresis nurse know if you are experiencing any of these symptoms during collection.
Although the procedure is well tolerated, most people are very tired at the end of the collection. This fatigue can last up to a week in some cases.
- If possible, try to arrange your schedule so that you have more time to rest and eat well during the week of the filgrastim administration and stem cell collection.
- You may wish to make arrangements to have someone with you who can drive you home afterwards. However, this is not required.
The Kraft Family Blood Donor Center offers individual DVD players and a movie library that you can use during the collection process.
- Cell phones, smartphones, laptops and tablets are permitted.
- Free wireless internet access is available in all patient areas.
- Please bring headphones if you’d like to watch a movie or listen to music on your own smartphone, tablet device, laptop computer, or music player.
The Recovery Period after PBSC Apheresis
The recovery period for peripheral blood stem cell collection varies from person to person. You may experience fatigue and discomfort for a short period. Fatigue may last for up to a week after the procedure. If you feel worsening pain and discomfort at any time after the collection, contact your care team.
Please refer to the comprehensive guide - Stem Cell Transplantation: An Information Guide for Patients and Caregivers for more information.