Acute myeloid leukemia stem cell transplant
Acute myeloid leukemia (AML) is a cancer of the blood that occurs when too many immature white blood cells are made in the bone marrow. AML is usually treated with chemotherapy, radiation therapy, and stem cell transplants.
Not all people with AML are eligible for a stem cell transplant. There are certain risks and complications that you should be aware of before deciding to have a transplant.
Stem cell transplants are also called bone marrow transplants. They are used as a treatment for cancers such as AML which destroy healthy cells in the bone marrow.
The first-line treatment for AML is chemotherapy to target cancer cells without damaging the healthy stem cells in the bone marrow around them.
Stem cell transplants start with a very large dose of chemotherapy that kills cancer cells and surrounding stem cells. The dose is strong enough to prevent cancer cells from coming back and to stop the bone marrow from making new normal cells. Radiation therapy can be used with chemotherapy in some cases.
After treatment, healthy stem cells can be transplanted into your bone marrow to replace cells that have been destroyed. Your body can use these cells to make non-cancerous blood cells. These new cells will work and reproduce as expected in your body.
There are two main types of stem cell transplants:
- Allogenic: a stem cell transplant that you receive from a donor (most common type)
- Autologous: a stem cell transplant that you receive on your own
Allogeneic stem cell transplants for AML
An allogeneic stem cell transplant uses donor stem cells from someone whose tissue type closely matches yours.
Often the best matched donor is a sibling or other close relative, but cells from unrelated donors matched to volunteers can also be used. Your transplant team will tell you how well your donors match and if there is a risk of complications.
Allogeneic transplants provide the benefit of the donor’s immune cells. These donated immune cells can help attack and destroy any remaining cancer cells in your body.
But these new immune cells could also see your whole body as a foreign invader and start attacking healthy tissue. This is called graft versus host disease (GvHD). This is one of the most serious potential risks of an allogeneic stem cell transplant.
Autologous stem cell transplant for AML
An autologous stem cell transplant uses your own stem cells. This is how it works:
- The cells are removed from your bone marrow and then frozen while you are undergoing high-dose chemotherapy treatment.
- Your frozen cells are processed to remove all AML cells.
- Your processed cells are then transplanted into your bloodstream.
Autologous stem cell transplants can be used if you cannot find a match for an allogeneic transplant. Since the cells you will receive are your own, the risk of complications is lower than what is often seen in allogeneic transplants.
But stem cell treatment doesn’t always kill all of the remaining cancer cells. The risk with an autologous stem cell transplant is that the cancer cells could be transplanted into your body.
You will likely have several tests before you receive a stem cell transplant to help the transplant team determine if you are a good candidate for this procedure. You will also likely meet social workers and therapists to help you prepare.
Many of the steps in a stem cell transplant are the same for allogeneic and autologous transplants. But an allogeneic transplant will start by locating a compatible donor. An autologous transplant begins by removing your stem cells.
Other steps in the procedure can begin after the stem cells from a donor or from your own blood are ready. This will include the following:
- Insertion of a central venous catheter (CVC). If you don’t already have a CVC, a medical expert may insert one into a vein in your chest or arm before your transplant to help with your chemotherapy and stem cell infusions.
- Receive high dose chemotherapy. You will receive high-dose chemotherapy to prepare your body for transplants. Radiation can also be used. The exact dose of chemotherapy depends on your type of transplant and your general health.
- Receive a stem cell infusion. The stem cells will be infused into your body by the CVC.
It may take 2 to 6 weeks for your new stem cells to start growing and reproducing in your bloodstream in a process called engraftment.
You can stay in the hospital during this time or go to a transplant center every day. You will have lab work done to measure and monitor your blood count.
Some possible side effects that you may experience during this process include:
It may take a year or more to feel fully recovered from a stem cell transplant. You can continue to:
- feels tired
- have trouble exercising
- have trouble concentrating
- suffer from memory loss
- have less interest in sex
- feeling depressed or anxious
- experiencing changes in your self-image
There are several possible risks of a stem cell transplant.
One of the most serious risks is GVHD. This only happens after allogeneic transplants and happens when donor cells attack your body after the transplant.
GVHD can be acute or chronic. It can be mild in some people and life threatening in others. The exact symptoms of GVHD can vary and will depend on the severity and type.
Other possible risks include:
- concerns about how your liver, kidneys, heart, or lungs are working
- loss of thyroid function
Doctors and transplant teams will monitor you for GVHD and other possible complications. It is important to let them know about any symptoms you may have. Treatment can help manage any complications that might arise.
Stem cell transplants are a treatment option for AML to replace bone stem cells that have been destroyed by AML.
Transplants can help some people go into remission. Talk to a doctor to find out more and see if you are a candidate for this type of treatment.