Leukemia stem cell transplants: What to know

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Leukemia is a type of cancer that affects the blood cells. It starts in the bone marrow but eventually enters the bloodstream, where it can affect other cells and organs in the body.

There are four main types of leukemia:

• acute myeloid, or myelogenous, leukemia
• chronic myeloid, or myelogenous, leukemia
• acute lymphocytic, or lymphoblastic, leukemia
• chronic lymphocytic leukemia

Lymphocytic leukemia develops in the white blood cells, whereas myeloid leukemia develops in both white and red blood cells.

Acute leukemia develops quickly and requires immediate treatment, while chronic leukemia develops more slowly over time.

Leukemia is most common among adults aged over 55 years, but it is also the most common cancer in children younger than 15 years old.

Stem cell transplants help with leukemia by enabling the body to replace damaged blood cells with healthy ones.

Stem cells can turn into many other types of cell. For example, the stem cells in the bone marrow can turn into:

• red blood cells, which carry oxygen around the body
• white blood cells, which fight infections
• platelets, which help the blood to clot when a person is bleeding

When a person receives a stem cell transplant, the body can start making new blood cells. Alongside high dose chemotherapy or radiation treatment, this procedure can cure leukemia or cause a long-lasting remission.

However, the process is long and often difficult. The potential benefits and risks depend on an individual’s circumstances.

Doctors can source stem cells from the bone marrow or blood, as well as from the umbilical cord, which pregnant people can choose to donate after they give birth. Doing so does not harm the parent or the baby.

In addition to donations from others, doctors may also use stem cells from inside the patient’s own body. This has some significant advantages to donor cells, as there is no risk the body will reject the cells as foreign material.

If a donor is necessary, there are several ways to harvest the stem cells:

• Bone marrow donation: This procedure requires general anesthesia. A doctor will take bone marrow from the pelvis using a large needle, collecting around 10% of the donor’s bone marrow. Bone marrow donation lasts for a few hours, and recovery can take several days. Sometimes, pain or fatigue can linger for a couple of weeks, but the risk of adverse effects or complications is low.
• Peripheral blood donation: This involves receiving daily injections of a medication that causes stem cells to enter the bloodstream. After several days, doctors take blood from the arm using a catheter. A machine then extracts the stem cells from the blood. Afterward, doctors give the remaining blood back to the donor. Overall, the procedure takes 2–4 hours. The medication for people undergoing this process can cause temporary side effects, such as bone pain and headaches.
• Cord blood donation: People who are pregnant can arrange to donate the unused blood in the umbilical cord after they give birth. It is advisable to do this as early as possible. A cord bank can then store the blood and give it to someone who is a good match. Alternatively, the parent can save it in case their relative needs it.

If a doctor is using the patient’s own stem cells, they will follow a similar procedure to extract the cells from the bone marrow or blood before the patient’s treatment begins.

The stem cell procedure involves multiple stages.

Evaluation

Before the transplant process can begin, a medical professional will assess how well a person might respond to a transplant.

They will carry out a number of diagnostic tests, including:

• blood tests
• an evaluation of physical and emotional strength
• bone marrow biopsy
• MRI or CT scans
• tests to measure the health of the heart and lungs

According to the American Cancer Society, people tend to have better outcomes with stem cell transplants if they:

• are young
• are in the early stages of leukemia
• have not already had a lot of treatment

Older adults and people with other serious conditions, such as heart or kidney disease, may not be eligible for a stem cell transplant. In some cases, a “mini-transplant,” which doctors call a nonmyeloablative transplant, may be possible instead.

If a doctor is using stem cells from the patient’s own body, they will collect the cells at this stage and freeze them.

Conditioning treatment

Doctors will administer chemotherapy, radiation therapy, or a combination of both to kill as many cancer cells as possible before the transplant.

This stage of treatment also suppresses the immune system, reducing the likelihood of the body rejecting the transplant, and can make room for new stem cells.

Typically, these are high dose treatments that take 1–2 weeks. People undergoing a mini-transplant will have lower doses.

Chemotherapy and radiation can cause significant side effects, such as hair loss, mouth sores, vomiting, diarrhea, and lung problems.

Transplant

Doctors deliver stem cell transplants through a blood transfusion. This typically takes around 1 hour. Side effects at this stage are rare. If they do occur, they are usually mild.

Recovery

After the transplant, medical professionals will monitor a person for signs that the stem cells are starting to “take,” or engraft. This usually takes 2–6 weeks.

During this time, a person will need to have regular blood tests and may need to take medications to prevent infections and other complications.

If a person is staying in the hospital, their medical team will discharge them once they seem stable enough. However, a person will need to continue recovering and taking precautions to avoid infections after they get home.

It can take 6–12 months or more for blood cell counts and the immune system to reach a normal level, and complications can develop 1 year or more after the procedure.

Stem cell transplants carry risks for the people receiving them. These include:

• Infection: During leukemia treatment and following a stem cell transplant, the body’s immune system is weakened. This makes a person more vulnerable to serious bacterial, fungal, and viral infections.
• Bleeding: As the body cannot make platelets during this treatment, a person may bleed excessively if they become injured. They may need to take precautions to avoid injuries. They may also need platelet transfusions.
• Graft-versus-host disease (GVHD): This occurs when donor cells attack the body of the person with leukemia, causing mild to severe symptoms. GVHD reactions are very common and can cause short- or long-term effects.
• Pneumonitis: This involves inflammation in the lung tissue. It is most likely to occur within the first 100 days following the transplant and can occur due to the effects of chemotherapy, radiation, or GVHD.
• Infertility: High dose chemotherapy and radiation treatment can damage the reproductive organs, causing infertility. Most people who undergo stem cell transplants become unable to conceive children naturally. However, people may be able to use fertility-preserving treatments prior to the procedure, such as freezing eggs or sperm.
• Relapse: For some, stem cell transplants can cure leukemia. However, the cancer can come back. While 80–90% of adults with acute lymphocytic leukemia will have complete remission at some point during treatment, half will experience a relapse.
• Second cancer: Radiation therapy and high dose chemotherapy can increase the risk of a person developing another type of cancer, even if the stem cell transplant is successful.
• Graft failure: This occurs when the body does not accept a donor’s stem cells. It is uncommon, and in some cases, doctors can treat it by giving another infusion of stem cells. In rare cases, it is fatal.
• Post-transplant lymphoproliferative disorder (PTLD): This condition can develop after a person receives donated stem cells. It happens when lymph cells grow out of control. It is fairly rare, but it is life threatening.

Having a stem cell transplant can also take a toll on mental health. People may find the experience frightening, stressful, or traumatic.

It is important that people seek help for the emotional effects of leukemia treatment if they find it difficult to manage them, whether the treatment is recent or happened long ago.

The cost of a stem cell transplant will vary depending on an individual’s location and health insurance. A person’s insurance provider can answer questions about this.

A 2016 study involving children with acute lymphoblastic leukemia found that the overall cost of stem cell transplantation over the course of the first year was $683,099. There were also substantial costs in the 4 years that followed.

It is important to feel prepared before a stem cell transplant. Some questions a person may want to ask their doctor about the procedure include:

• Am I eligible for a stem cell transplant?
• What type of transplant should I have?
• How do you identify a good donor?
• What can I do to prepare?
• What happens if there are complications?
• What are the chances of remission or relapse?
• Can I get support for my mental health during or after treatment?
• How soon can I return to daily activities?

Leukemia is a type of cancer that affects the blood cells. A stem cell transplant can allow the body to start making new, healthy blood cells. The stem cells may come from the patient or a donor.

In some cases, a stem cell transplant can cure leukemia. However, there are risks and side effects to consider. It is important to discuss the benefits and risks with a doctor in order to make an informed decision.