Stem cell transplant for AML
Some people may be offered a stem cell transplant after high-dose chemotherapy. This involves a further course of intensive chemotherapy and/or radiation therapy followed by a transplant of stem cells.
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 myeloid leukaemia (AML), 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, your doctor will consider other options, such as an overseas donor, a partially matched donor or a cord blood transplant. Half-matched family donors are increasingly used for people who don’t have a readily available matched donor – this is called a haploidentical transplant.
A transplant that uses stem cells collected from your own body is known as an autologous transplant, but this is rarely used to treat AML in Australia.
Although a stem cell transplant can help some people, it is not suitable for everyone. The high-dose chemotherapy that is given before the transplant can have a lot of side effects. The main steps in an allogeneic stem cell transplant are described below.
I was told that my best chance was to have a bone marrow transplant, but it would depend on finding a suitable donor.— Read more of Sue’s story
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 cells 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 cells collectedStem cells are usually collected from the donor via a process called apheresis. A needle 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 a needle is inserted into their pelvic bone to remove the marrow.
3. CryopreservationThe 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 for transplant (viable).
4. Conditioning treatmentYou may have high-dose chemotherapy and/or total body irradiation 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, so it 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.
A/Prof John Moore (Conjoint UNSW), Senior Staff Specialist Haematology, Department of Haematology and Bone Marrow Transplant, Kinghorn Cancer Centre, St Vincent’s Hospital; Glynda Blomson, Consumer; Kevin Bloom, Senior Social Worker, Haematology and Bone Marrow Transplant, Royal North Shore Hospital; Sharon Frazer, Consumer; 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; Karen Maddock, Clinical Nurse Consultant – Haematology, Westmead Hospital.
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