Bone marrow and stem cell transplants for chronic myeloid leukaemia (CML)
This page is about intensive treatment for chronic myeloid leukaemia (CML). There is information about
Bone marrow and stem cell transplant for chronic myeloid leukaemia
The aim of a bone marrow or stem cell transplant is to try to cure your chronic myeloid leukaemia or control it for longer than other types of treatment can. Transplants are mainly used for patients whose CML has not responded to biological therapy treatment. A bone marrow transplant or stem cell transplant involves having high dose chemotherapy. You may also have radiotherapy to your whole body. This destroys the leukaemia cells but also your bone marrow cells. Bone marrow is the spongy substance inside your bones that makes all your blood cells.
After this intensive treatment you have donor bone marrow or stem cells through a drip into a vein. This is called an allogeneic transplant. The donor stem cells then make their way into your bone marrow and start to make new blood cells again. At the moment, the only known cure for CML for some people is a transplant with someone else’s bone marrow or stem cells.
You can view and print the quick guides for all the pages in the Treating CML section.
The aim of a bone marrow or stem cell transplant is to try to cure your CML or control it for longer than other treatments can. Your age and general level of fitness is an important consideration when deciding whether this type of treatment is suitable for you. This is because it is very intensive treatment and there is a risk that you may not survive it. Generally, you have to be younger than 65 years old, but some people who are older but very fit and healthy may be able to have it.
You have very high dose chemotherapy. You may also have radiotherapy to your whole body as part of this treatment. As well as destroying the leukaemia cells, the treatment destroys your bone marrow cells. The bone marrow is the spongy substance inside your bones. It contains cells called stem cells, which make all your blood cells. So, after high dose chemotherapy you have bone marrow or stem cells from a donor through a drip into your bloodstream. This is called an allogeneic transplant.
There may be a choice about whether you have bone marrow or stem cells. Your doctor may prefer one type of treatment to the other. You need to discuss this with your doctor. The choice is too individual for us to give general information here.
Bone marrow contains stem cells. So the result of intensive treatment is the same whether you have a stem cell or bone marrow transplant. The main differences are
- To have bone marrow collected your donor needs a general anaesthetic
- For stem cell collection your healthy donor needs to have growth factor injections to get the stem cells out into the bloodstream for collection
- Bone marrow collection is done during one procedure involving a hospital stay of a few hours
- Stem cell collection involves your stem cell donor giving cells over a couple of weeks and each time the collection takes up to 4 hours
- Your blood counts may recover more quickly after a stem cell transplant
The donor's cells have to match your own. The most suitable donor is usually a close relative, such as a brother or sister. There is a 1 in 4 chance of a brother or sister being a good match.
It is sometimes possible to get a match from a donor who is not a relative. If you need this treatment, your doctor will approach the Anthony Nolan Bone Marrow Register to find a matched unrelated donor (MUD).
To make sure that your donor's cells match your own, you will both have blood tests. The tests see how many of the proteins on the surface of the blood cells are the same. This is called tissue typing or HLA matching. HLA stands for human leucocyte antigen.
Once you have a donor, they will be asked to go to the hospital and give bone marrow or have stem cells collected. The collection (harvest) will be timed for when your high dose chemotherapy, and possibly radiotherapy, has finished. This is so that you can have the drip of stem cells or bone marrow as soon after the collection as possible.
This is sometimes called a bone marrow harvest. It means your donor has a minor operation under general anaesthetic.
To remove the marrow, the doctor puts a needle through the skin into the donor's hipbone. The doctor then uses a large syringe to suck out the marrow. About 2 pints of marrow are needed. To get enough, the doctor usually has to put the needle into several different parts of the pelvis. Occasionally, the doctor uses the chest bone (sternum) as well.
When the donor wakes up, they will have up to 6 needle puncture sites. Usually they will feel a bit bruised and may need paracetamol for a few days. They usually need to stay in hospital overnight after a bone marrow harvest. This is to make sure they have recovered from the anaesthetic. They may also need a blood transfusion.
Stem cells are very early blood cells. They are normally found in the bone marrow. Doctors use growth factor injections to make some of them move into the bloodstream. This makes it easier to collect them. You have growth factors as an injection just under the skin, usually in your tummy (abdomen), or into an arm or a leg. You have these once a day, for up to 10 days at a time and can learn to give them yourself at home.
Growth factor injections can cause itching around the injection site. You may have some aching in your bones after you have had a few injections. This is because there are a lot of blood cells being made inside the bones. The aching is usually easy to control with a mild painkiller, such as paracetamol. The pain will go away after a day or so.
After your course of injections, you will have regular blood tests to see how many stem cells are in your blood. When there are enough, you will have them collected. Collecting stem cells takes 3 or 4 hours. You lie down on a couch and have a fine tube put into a vein in each of your arms. The nurse attaches these to a machine called a stem cell separator. Your blood passes out of one drip, through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood but gives you the rest of the cells and the plasma back. The donor stem cells are frozen and stored.
To have your high dose chemotherapy you will need to have quite a few drugs into your bloodstream. This may take 5 or 6 days. Beforehand, your doctor will arrange for you to have a central line put in. A central line is a long, bendy plastic tube that delivers your drugs straight into one of the main blood vessels in your upper chest. There are several different types of central line, including PICC lines (peripherally inserted central catheters) and ports.
Some central lines go into the centre of your chest and run under your skin up to your collarbone. Here is a diagram, showing where the line goes.
PICC lines go into your arm, in a similar place to a normal drip. The line runs up inside the vein to your shoulder.
Ports are small chambers, placed under your skin, that are connected to the rest of the central line tube inside your body. Your nurse puts a needle through the skin into the port each time you have chemotherapy. There is more about all these types of central lines in the main chemotherapy section.
After you have finished all your treatment, you have your bone marrow back. This is just like having a blood transfusion. The stem cells or bone marrow drips into your central line and into your bloodstream. The cells find their way back into your bones and start to grow again. Soon they start to make new blood cells for you.
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.
Doctors are investigating a new type of transplant that they hope will have less severe side effects. It is called a reduced intensity conditioning transplant (RIC) or a mini transplant. You have lower doses of chemotherapy, so the side effects are not as bad. This treatment may not kill all your bone marrow cells. If it doesn't, you have more infusions from your donor after your transplant. This is called donor lymphocyte infusion. There is more about mini transplant on the page about CML research.
There is general information about bone marrow and stem cell transplants in the cancer treatment section, including detailed information about the side effects. You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to help you.
You can also get information and support from one of the chronic leukaemia organisations. They often have fact sheets and booklets they can send.
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