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Stem cell transplant for acute myelogenous leukemia
Some people with acute myelogenous leukemia (AML) will have a stem cell transplant. Stem cells are found in the bone marrow, the bloodstream and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells.
A stem cell transplant is used to replace stem cells when stem cells or bone marrow are damaged. They can be damaged by disease or destroyed by high doses of chemotherapy or radiation therapy. You may be offered a stem cell transplant to treat AML:
- during first complete remission
- after an early relapse and second complete remission is reached
A stem cell transplant is a very risky and complex procedure that must be done in specialized transplant centres or hospitals.
Types of transplants used for AML
The following types of stem cell transplant may be used with AML.
In this type of transplant, the stem cells are taken from one person (the donor) and are given to another person (the recipient). The donor may be a relative or may be unrelated to the recipient. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.
An allogeneic transplant is the preferred type of stem cell transplant used to treat AML. But not everyone can have an allogeneic transplant because they need to have a matched donor.
The side effects of the high doses of chemotherapy used before stem cell transplant may be too severe for people over the age of 55 years. People in this age group may also have other health conditions that mean they can’t have an allogeneic transplant. They may be offered a reduced-intensity transplant, which uses a lower dose of chemotherapy for the conditioning treatment.
In this type of transplant, the stem cells are taken from your own bone marrow or blood. An autologous transplant is sometimes used if there is no matched donor.
Donor lymphocyte infusion
A donor lymphocyte infusion (DLI) may be given if AML relapses after a stem cell transplant. The lymphocytes usually come from the original stem cell donor. DLI causes an intense immune reaction against the AML cells. It may be able to remove leukemia cells that are still in the blood and bone marrow.
Side effects can happen with any type of treatment for AML, but everyone’s experience is different.
Side effects can develop any time during, immediately after or a few days or weeks after a stem cell transplant. Sometimes late side effects develop months or years after a stem cell transplant. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of a stem cell transplant will depend mainly on the type of chemotherapy drug or drug combination given, if radiation therapy was given, the type of transplant and your overall health. Common side effects of a stem cell transplant include:
- low blood cell counts (called bone marrow suppression)
- skin problems
- hair loss
- graft-versus-host disease (GVHD)
- veno-occlusive disease
Tell your healthcare team if you have side effects that you think might be from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Questions to ask about stem cell transplant
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.