For your post-remission therapy, your doctor may recommend high-dose chemotherapy followed by a stem cell transplantation. Although it's not the only type of stem cell transplantation, an allogeneic stem cell transplantation is the most common type used to treat acute lymphoblastic leukemia (ALL). However, an allogeneic stem cell transplantation is a high-risk procedure and may not be a good choice for every ALL patient as each patient is different.

Your doctor first looks at whether you have high-risk ALL or standard-risk ALL:

• If you have high-risk ALL and are in your first remission period: An allogeneic transplant may be an option if you have a matched related donor or a matched unrelated donor if a related donor isn't available.
• If you have standard-risk ALL and are in your first remission period: The choice between allogeneic transplant and continued chemotherapy is less clear. You and your doctor should discuss whether a standard allogeneic transplant or a reduced-intensity transplant is right for you.

The procedure may be a consideration for you if:

• You're not doing well with other treatments
• The expected benefits of stem cell transplant exceed the risks
• A matched donor is available
• You're at high risk of relapse
• You relapse after prior successful treatment

The decision to do a stem cell transplant also depends on:

• Your overall health
• The likelihood that the disease will respond to the procedure's conditioning
• Regimen of intensive chemotherapy
• The features of your leukemia
• Your understanding of the transplant's benefits and risks

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 ALL cells

The decision to do a stem cell transplant depends on:

• The availability of a matched donor
• Your response to drug therapy
• Your understanding of the transplant's benefits and risks

Reduced-Intensity Allogeneic Stem Cell Transplantation

The benefits and risks of reduced-intensity allogeneic stem cell transplantation have not yet been clearly established for ALL patients. Patients who are too old or too ill to have a standard allogeneic stem cell transplant may be candidates for a reduced- intensity transplant if a suitable donor is available. The conditioning therapy used for a reduced-intensity transplant is of lower intensity than that for a standard allogeneic stem cell transplant; it does not completely inactivate the patient’s immune system or treat the ALL as aggressively

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.

Related Links

• Stem Cell Transplantation
• Managing Side Effects
• Integrative Medicine and Complementary and Alternative Therapies
• Food and Nutrition
• Download or order The Leukemia & Lymphoma Society's free booklet Blood and Marrow Stem Cell Transplantation