Stem cell transplant for ALL
Some people may be offered a stem cell transplant after consolidation chemotherapy. This involves a further course of intensive chemotherapy and/or radiation therapy followed by a transplant of stem cells. The steps in the process are described below.
A stem cell transplant is not suitable for everyone, especially people with other health problems.
Stem cells are unspecialised, blood-forming cells that can be taken from the bloodstream (peripheral blood stem cell transplant), bone marrow (bone marrow transplant), or umbilical cord blood (cord blood transplant).
Finding a donor
For acute lymphoblastic leukaemia (ALL), stem cells are usually collected from another person. This is known as an allogeneic transplant. A suitably matched donor could be a relative or an unrelated person found through the Australian Bone Marrow Donor Registry.
It can sometimes be hard to find a suitable donor. In this case, an overseas donor, a partially matched donor or a cord blood transplant may be considered. Half-matched family donors are increasingly being used (a haploidentical transplant).
Steps in an allogeneic stem cell transplant
This is a general outline of a transplant using stem cells collected from another person, but the process may vary from hospital to hospital. Your transplant team will let you know what to expect.
More detailed information about stem cell transplants is available at Leukaemia Foundation.
1. Stem cell stimulatedA suitably matched donor is found. They may be a close relative, or an unrelated donor found through an Australian or overseas donor registry.
In some cases, the donor is given injections of a growth factor drug known as granulocyte–colony stimulating factor (G-CSF) for 4–7 days. This helps stem cells multiply quickly and move out of the bone marrow into the blood.
2. Stem cell collectedStem cells are usually collected from the donor by a process called apheresis. A thin plastic tube called a cannula is inserted into a vein in each arm. Blood is taken from the donor, passed through a machine to remove the stem cells and then returned to the donor’s body. This takes 3–4 hours and is usually done during a day visit to the hospital.
Less often, stem cells may be collected from the bone marrow. The donor is given a general anaesthetic and then a needle is inserted into their pelvic bone to remove the marrow.
3. Stem cells preservedThe stem cells from the donor are processed. They may be given to you on the same day they are collected or frozen using liquid nitrogen (cryopreservation).
If the stem cells are collected at another hospital or imported from another country, they will be transported at a set temperature to keep them alive and in good condition (viable) for transplant.
4. Conditioning treatmentYou may have high-dose chemotherapy and/or total body irradiation (radiation therapy to the whole body) before the transplant. These treatments aim to destroy any remaining leukaemia cells. They will also destroy the stem cells in your bone marrow, making room for new stem cells to grow.
Some people will have reduced intensity conditioning (RIC). This means lower doses of chemotherapy and radiation therapy are used for the transplant, which is easier for the body to tolerate.
Learn ways to manage some common side effects of high-dose chemotherapy.
5. Stem cells transplantedA day or so after the conditioning treatment, the donor’s stem cells are put into your body (infused) through a cannula or intravenous drip. This is similar to a blood transfusion and takes about an hour.
You may have stomach cramps and feel sick (nauseous), which can be managed with medicine.
6. EngraftmentOver the next couple of weeks, the donated stem cells will develop into new blood cells, allowing your bone marrow to recover. This is called engraftment. You’ll be given drugs to reduce the risk of the transplanted cells attacking your body (graft-versus-host disease or GVHD).
You will usually stay in hospital for 3–4 weeks until you are well enough to go home. In some cases, you may be able to have the transplant as an outpatient.
Once you go home, you’ll need weekly check-ups for the first few months after the transplant. These will usually become less frequent over time.
Podcast: Making Treatment Decisions
Dr Jonathan Sillar, Haematologist, Calvary Mater Newcastle Hospital; Dr Scott Dunkley, Haematologist, Royal Prince Alfred Hospital and Chris O’Brien Lifehouse; Sharon Frazer, Consumer; Dr Robin Gasiorowski, Staff Specialist, Haematology, Concord Hospital; Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Heather Mackay, Clinical Nurse Consultant – Haematology, Westmead Hospital; Katelin Mayer, Clinical Nurse Consultant, Cancer Outreach Team, Nelune Comprehensive Cancer Centre.
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