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Bone marrow or stem cell transplants for ALL

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This page tells you about intensive treatments for acute lymphoblastic leukaemia. You can find information about

 

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Bone marrow or stem cell transplants for ALL

Bone marrow and stem cell transplants for ALL are part of treatments called intensive treatments. Intensive treatment is high dose chemotherapy, and sometimes total body irradiation (TBI). This treatment kills off all your bone marrow cells. The bone marrow is the spongy substance inside your bones. It contains the stem cells that make all your blood cells. Doctors need to replace the stem cells so you survive the treatment. You will most probably have the stem cells replaced by a drip of someone else’s bone marrow or stem cells. Or you might have them replaced by your own bone marrow stem cells. But this is rarely used these days. 

The choice between a donor transplant and having your own bone marrow or stem cells depends on a number of different factors, including

  • The type of leukaemia you have
  • Whether you have a close relative whose blood cells closely match yours

Having your transplant

After your chemotherapy and radiotherapy, you have the bone marrow or stem cells through a drip, into a vein. The cells find their own way to the centre of your bones. They begin to make blood cells after a few days or weeks. You usually have to stay in hospital for a few weeks while your blood cell counts are very low.

 

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What intensive treatments are

If you have acute lymphoblastic leukaemia (ALL), your doctors may suggest intensive treatment to try to cure your leukaemia. Intensive treatment is high dose chemotherapy, and sometimes total body radiotherapy. This treatment kills off all your bone marrow cells. The bone marrow is the spongy substance inside your bones. It contains the stem cells that make all your blood cells. Doctors need to replace your stem cells so you survive the treatment. You may have your stem cells replaced by a drip of

  • Someone else’s bone marrow or stem cells
  • Your own bone marrow or stem cells (this is rarely used these days)

The choice between a donor transplant and having your own bone marrow or stem cells depends on a number of different factors, including

  • The type of leukaemia you have
  • Whether you have a close relative whose blood cells closely match yours.
 

Stem cells

Stem cells are very early blood cells. Your bone marrow makes them. When you have a growth factor injection, the stem cells move from the bone marrow into the bloodstream. Your doctors then collect them with a machine called a cell separator. This process is called leucopheresis (pronounced loo-koh-fur-ee-sis).

You have a drip put into each of your arms. The drips attach to the machine. Your blood passes out of one of the drips and goes through the machine. The machine filters out the blood cells and passes the blood back into your body through the other drip.

Your doctors freeze the stem cells and store them until after you have had your high dose chemotherapy (and possibly radiotherapy).

Stem cell transplants are similar to bone marrow transplants, but your blood count recovers more quickly. So you are at risk of infection for a shorter time than with a bone marrow transplant. A lot of research has looked into using stem cells in the past few years. You can now have a transplant using a relative's stem cells and even donor stem cell transplants from a completely unrelated donor. Giving stem cells rather than bone marrow is better for the donor. You don't need an anaesthetic to have stem cells collected and tend to recover more quickly.

 

Having bone marrow taken

Having bone marrow taken is called a bone marrow harvest. It is a minor operation under general anaesthetic. The doctor sucks out the marrow from your hipbones, and sometimes your breast bone, with a large syringe. Usually you will feel very bruised and may need a mild painkiller such as paracetamol for a couple of days.

 

Having your own stem cells or bone marrow

With an auto transplant you have your own stem cells or bone marrow taken, stored and given back after your treatment. Your doctors will try to collect stem cells first. If they can't get enough, they may then try to collect your bone marrow. This treatment is rarely used for ALL.

You have marrow or stem cells collected when there is no sign of leukaemia (remission). The cells or marrow are then frozen until you have had your high dose chemotherapy, and possibly radiotherapy. Then they are defrosted and given back as a drip, through your central line. Because of the risk of infection, you have to stay in an isolation room until your marrow or stem cells have started to make new blood cells again.

 

Having stem cells and bone marrow from someone else

Having someone else’s marrow or stem cells is called a donor transplant, or an allogeneic transplant. This is pronounced a-low-gen-ay-ik.

The donor’s bone marrow cells must match your own as closely as possible. The most suitable donor is usually a close relative, such as a brother or sister. It is sometimes possible to find a match in an unrelated donor. Doctors call this a matched unrelated donor (MUD). To find out if there is a suitable donor for you, your doctor will contact The Anthony Nolan Bone Marrow Register.

To make sure that your donor’s cells match, you and the donor will have blood tests. These are to see how many of the proteins on the surface of their blood cells match yours. This is called tissue typing or HLA matching. HLA stands for human leucocyte antigen.

Once you have a donor and are in remission, you have your high dose chemotherapy and radiotherapy. A week later the donor comes into hospital and their stem cells or marrow are collected.

You then have the stem cells or bone marrow as a drip through your central line.

If you've had a transplant from a donor, there is a risk of graft versus host disease (GVHD). This happens because the transplanted stem cells or bone marrow contain cells from your donor's immune system. These cells can sometimes recognise your own tissues as being foreign and attack them. This can be an advantage as the immune cells may also attack cancer cells left after your treatment.

Acute GVHD starts within 100 days of the transplant and can cause

  • Diarrhoea 
  • Weight loss 
  • Changes in the way your liver works 
  • Skin rashes 

If you develop GVHD after your transplant, your doctor will prescribe drugs to damp down this immune reaction. These are called immunosuppressants.

Chronic GVHD starts more than 100 days after the transplant and you may have skin rashes, diarrhoea, sore joints and dry eyes. Your doctor is likely to suggest that you stay out of the sun because GVHD skin rashes can often get worse in the sun.

There is more detailed information about graft versus host disease.

 

Having your transplant

After your chemotherapy and radiotherapy, you have the bone marrow or stem cells through a drip, into a vein. The cells find their way to the centre of your bones and begin to make blood cells after a few days or weeks.

Person having a transplant

While your blood cell counts are very low you usually have to stay in hospital. This may be for a few weeks at least. You will be at risk of picking up infections during this time. You will need anti viral and antibiotic treatments. Sometimes you may need anti fungal treatments.

You are very likely to get infections and they may make you feel very ill and low. Make sure you tell your doctors or nurses about anything you think might be an infection. It is important to start treatment as soon as possible.

Many people find it hard to eat after such intensive treatment. This may be because your digestive system is very upset and sore after all your chemotherapy and radiotherapy. Or it may be because you have a very sore mouth. Your dietician may give you meals in a drink.

If you have lost a lot of weight during treatment, your doctors may order liquid food that you have through your central line. This gives you all the calories you need while you recover. Your nurses will still encourage you to eat, so you can start getting back to normal. Once you are able to eat and drink again, you will slowly be able to replace the liquid feeds with normal meals.

You can find out more about stem cell and bone marrow transplants in the cancer treatment section.

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Updated: 12 May 2015