Your doctor may recommend an allogeneic stem cell transplantation or an autologous stem cell transplantation to treat your acute myeloid leukemia (AML). Stem cell transplantation isn't an option for everyone, especially because of the high, sometimes life-threatening risks associated with it.
Favorable-risk AML: A stem cell transplantation generally isn't recommended with a first complete remission.
Intermediate-risk AML: The doctor may recommend an allogeneic stem cell transplantation or a reduced-intensity allogeneic transplantation.
High-risk AML: Doctors generally recommend allogeneic stem cell transplantation with first remission if you have a matched related or unrelated donor. If you're older or you have any comorbidities or conditions like heart disease, kidney disease, lung disease or diabetes, your doctor may recommend a reduced-intensity allogeneic transplantation.
Allogeneic Stem Cell Transplantation
Allogeneic stem cell transplantation involves transferring stem cells from a healthy person (the donor) to the patient. The procedure follows high-intensity chemotherapy, potent drugs that must be toxic enough to kill leukemic cells. Unfortunately, the drugs also take aim at normal stem cells in the bone marrow.
The main reasons for doing an allogeneic stem cell transplant are:
- To start a new supply of red cells, white cells and platelets with help from the transplanted donor stem cells
- To give strong doses of chemotherapy to kill CML cells
The decision to do a stem cell transplant depends on:
- The availability of a matched donor
- Your response to oral drug therapy
- Your understanding of the transplant's benefits and risks
Reduced-Intensity Allogeneic Stem Cell Transplantation
If you can't tolerate allogeneic with high-intensity chemotherapy, you may be eligible for reduced-intensity stem cell transplantation (sometimes called nonmyeloablative transplant). This type of transplant is a modified version of allogeneic transplantation that's been effective for many CML patients.
To prepare for the transplant, you undergo less-intense conditioning treatment compared with a standard allogeneic transplant. The chemotherapy destroys most cancer cells with a standard transplant. Reduced-intensity conditioning doesn't destroy many cancer cells but instead relies on the donor's immune cells to fight the disease. This attack is called the graft-versus-tumor (GVT) effect.
Graft Versus Host Disease
A serious risk of allogeneic and reduced-intensity allogeneic stem cell transplantation is graft versus host disease (GVHD), which develops if the donor's immune cells attack your normal tissue. GVHD's effects can range from minor to life threatening.
Autologous Stem Cell Transplantation
Autologous stem cell transplantation involves "harvesting," or retrieving, noncancerous stem cells from the patient’s own body and freezing them. The cells are returned to the patient’s body after receiving intensive chemotherapy. The procedure is only appropriate for certain patients.
The question of which patients are likely to benefit from transplantation after their first complete remission is under study in clinical trials. The decision to do a stem cell transplant depends on whether the patient’s AML is favorable risk, intermediate risk or high risk (see below). The doctor also considers:
- The patient’s overall health
- The chances that chemotherapy alone will cure the AML
- The type of abnormal changes to the chromosomes and cells
- The availability of a matched donor, if necessary
- The patient’s understanding of the benefits and risks of transplant
- Stem Cell Transplantation
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- Download or order The Leukemia & Lymphoma Society's free booklet Blood and Marrow Stem Cell Transplantation