Stem cell transplant for acute myeloid leukaemia
Some people may be offered a stem cell transplant after induction and consolidation 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).
For acute myeloid leukaemia (AML), stem cells are usually collected from another person. This is known as an allogeneic transplant. A matched donor could be a relative or an unrelated donor via the Australian Bone Marrow Donor Registry, but it can sometimes be hard to find a suitable donor. In this case, the doctor will consider other options, such as a partially matched donor, a cord blood transplant, or an overseas donor. A transplant that uses stem cells collected from your own body is called an autologous transplant, but this is rarely used for AML in Australia.
A stem cell transplant is a demanding treatment and is not suitable for everyone, especially people with other health problems. The main steps in the process 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.
Stem cell transplant steps
1. Donor stem cells stimulated
A genetically matched donor is found. They may be a close relative, or an unrelated donor from 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 5-10 days. This helps stem cells multiply quickly and move out of the bone marrow into the blood.
2. Stem cells collected
Stem 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, then blood is taken through one of the cannulas and passed through a machine called a cell separator. The stem cells are removed and the rest of the blood is returned to the donor through the other cannula. This continuous process takes 3-4 hours.
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.
The stem cells are processed and frozen using liquid nitrogen (cryopreserved). If the stem cells are being 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 treatment
You may have high-dose chemotherapy or total body irradiation before the transplant. These treatments aim to destroy any remaining cancer cells. They kill the blood-forming stem cells in your bone marrow, making room for new cells to grow. Some people will have a less intensive treatment known as reduced intensity conditioning (RIC).
Side effects may include nausea, mouth sores, hair loss, flu-like symptoms such as body aches, and high risk of infections. Learn about ways to manage some common side effects.
5. Stem cells transplanted
A day or so after high-dose conditioning treatment, the donor’s stem cells are given to you (infused) through a cannula or via an intravenous drip. This is similar to a blood transfusion and takes about an hour.
You may have stomach cramps and feel nauseous, which can be managed with medicine.
Over the next couple of weeks, your 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 own cells (graft-versus-host disease or GVHD).
You will usually stay in hospital for 1âˆ’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 check-ups every week or so, but these will usually become less frequent over time.
Dr Anoop Enjeti, Senior Staff Specialist Haematologist, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle; Ray Araullo, Deputy Head, Social Work Department, Royal North Shore Hospital; Shehaan Fernando, Consumer; Narelle Greentree, Clinical Nurse Specialist, Hunter Haematology Unit, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Karen Maddock, Haematology Clinical Nurse Consultant, Westmead Hospital; Melanie Sexton, Consumer; Dr Jonathan Sillar, Haematology Registrar, Calvary Mater Newcastle, and Conjoint Fellow, The University of Newcastle.
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