There are four main steps in the process of both high-dose treatment with stem cell support and allogeneic transplants. These are described briefly below and explained further throughout this section.

The first step is to reduce the leukaemia or cancer to as low a level as possible, using chemotherapy and/or radiotherapy. Ideally you should have no detectable cancer (this is known as being in remission) at the time of your high-dose treatment. This gives the best possible chance for the treatment to work. However, it may also be done if there is only a small amount of cancer still present.

The second step is the collection of the stem cells from you or your donor. This is known as the harvest.

The third step is the high-dose treatment. The aim is to remove any remaining cancer cells from your body. You may be treated with chemotherapy alone. Sometimes radiotherapy is given as well. This intensive treatment will completely destroy all your normal bone marrow. This step is sometimes called the conditioning regimen and usually lasts only a few days. It can make you feel very ill and sick. You will be given anti-sickness (anti-emetic) drugs, which may also make you feel sleepy. These drugs are very effective, and can usually control feelings of sickness (nausea) and vomiting.

The fourth step is to give the stem cells to you through a drip. This is a bit like having a blood transfusion. It will be 2–4 weeks before the cells find their way through the bloodstream into the bone marrow and start to make new blood cells for you. You will need to be in hospital until the number of blood cells in your blood stream has gone back to a safe level.

While your level of healthy blood cells is low, you will need to have antibiotics. This is because you will have very little resistance to infection. You may be given injections of growth factors (G-CSF) to help your bone marrow to make new blood cells more quickly. You will also need to have blood and platelet transfusions. You may be looked after in a room on your own to protect you from infection. During this time you will need constant medical and nursing support.

Before you have any treatment your doctor will explain the aims of the treatment to you. You will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are to have
• the advantages and disadvantages of the treatment
• any other possible treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you, and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

It is important to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.