Bone marrow or stem cell transplants for AML

If you have acute myeloid leukaemia (AML) your doctors may suggest intensive treatment to try to cure it. 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. Your doctors need to replace the stem cells so that you survive the treatment. You have the stem cells replaced by a drip (transfusion) of

• Someone else’s bone marrow or stem cells (a donor transplant)
• Your own bone marrow
• Your own stem cells – this is not common for AML

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 are very early blood cells made by the bone marrow. To collect the stem cells your donor has growth factor injections. This makes the bone marrow produce more stem cells, and they move from the bone marrow into the bloodstream. A nurse or technician can then collect them from the blood with a machine called a cell separator. This process is called leucopheresis (pronounced loo-koh-for-ee-sis).

To collect the stem cells the donor has a drip put into each of their arms. The drips attach to the machine. Their blood passes out of one of the drips and goes through the machine. The machine filters their stem cells out and then passes the blood back into their body through the other drip. If you are going to have a transplant of your own stem cells, you also have them collected in this way.

You can find more detailed information about this in our section about stem cell transplants.

The nurse or technician then freezes the stem cells and stores them until you are ready to have your transplant.

Collecting bone marrow from you or your donor is called a bone marrow harvest. It is a minor operation under general anaesthetic. The doctor uses a large syringe to suck out the bone marrow from the hip bones and sometimes the breast bone. Usually you or your donor will feel very bruised for a few days afterwards, and will need to take painkillers, such as paracetamol.

You can find more detailed information about collecting bone marrow in our bone marrow transplant section.

Auto transplant is also called an autologous transplant. It is pronounced or-toll-oh-gus tranplant. With an auto transplant you have your own stem cells or bone marrow taken, stored and given back after your treatment. This is not a very common treatment for AML.

You have your bone marrow or stem cells collected when there is no sign of leukaemia (remission). The cells or marrow are frozen until you have had your high dose chemotherapy, and possibly radiotherapy to the whole body (total body irradiation). Then, after defrosting the bone marrow or stem cells, you have them back as a drip through your central line. Due to the risk of infection, you need to stay in an isolation room until your bone marrow or stem cells have started to make new blood cells again.

Having someone else’s marrow or stem cells is called a donor transplant, or an allogeneic transplant. This is pronounced al-lo-jen-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 and other UK based and international bone marrow registers. 

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 goes 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 because the immune cells may also attack any leukaemia 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 medicines 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 detailed information about graft versus host disease in the section about coping physically with cancer.

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 need to stay in hospital while your blood cell counts are very low. This may be for a few weeks at least. You will be at risk of picking up infections and will need anti viral and antibiotic treatments. Sometimes you may need anti fungal treatments. You are likely to be looked after in a single room (in isolation).

It is very unusual for anyone to get through this treatment without picking up infections. Make sure that you tell your doctors or nurses if you think that you have signs of an infection. It is important to start treatment as soon as possible. Infections may make you feel very ill and low.

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 (nutrition) that you have through your drip. 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 can slowly replace the liquid feeds with normal meals.

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

You may have a single room in the hospital ward, to help protect you from infection. You stay in the single room until your bone marrow has started to make blood cells again and your blood counts have come up. This can take a few weeks.

While you are in isolation you can have visitors, but your nurses may suggest that you only have one or two each day. Your friends and relatives should not come to see you if they are not well, or think they have been in contact with anyone with an infectious disease.

Being looked after in a single room can feel lonely. Some people find it frightening. It can help to talk to the nurses about your worries. They can reassure you.

Taking in some of your personal things can make the room feel more homely. Books, photographs and an ornament or two can brighten it up. You can also take in a mobile phone, laptop, electronic tablet or music player to make the time pass more enjoyably and keep in touch with friends and family.