High dose (or conditioning) treatment for ALL includes high doses of chemotherapy. You might also have radiotherapy or targeted cancer drugs, or both.
The main aim is to destroy any remaining leukaemia cells. But it also kills the stem cells that make blood cells in the bone marrow. This means you need a way of replacing (transplanting) the stem cells that have been destroyed. In ALL you usually have stem cells from someone else (a donor).
This page is about having high dose treatment and an infusion of stem cells. For information about:
- what a transplant is
- the types of transplant
- how stem cells are collected
- the side effects of having a transplant
Your doctor might recommend that you have lower doses of chemotherapy as part of your transplant. And you may not have radiotherapy. This is called reduced intensity treatment and is part of a mini transplant (reduced intensity transplant).
It might be used for older people and those who are not fit or well enough to have high dose treatment. The lower dose chemotherapy reduces the number of stem cells in your bone marrow rather than destroys them all. It means that you generally have less severe side effects compared to high dose chemotherapy.
Having high dose treatment
You have high dose treatment before your transplant of stem cells.
You have the chemotherapy drugs through a tube put into a major vein in your chest (a central line). These drugs go into your bloodstream and travel around your body.
You also have other drugs through your central line to support you through your transplant. For example, anti sickness medicines and antibiotics. And your nurse can take blood from your central line for tests.
You usually have high dose chemotherapy for about 5 or 6 days.
Total body irradiation
Depending on your treatment schedule you might have radiotherapy to your whole body. This is called total body irradiation (TBI). You have TBI to help kill any leukaemia cells left behind after chemotherapy.
You usually have radiotherapy after high dose chemotherapy, just before your stem cell transplant.
First you have a planning session to create a treatment plan. This takes about an hour, but it can vary slightly between hospitals.
You have a CT scan and the radiographers take several measurements. Once the scan is complete your radiographer makes two small permanent marks on your pelvis. They use these marks to help position you in the same place when you go for your treatment.
During this session, you might have a very small dose of radiotherapy. This is a test dose to help with the planning of your treatment.
Your treatment sessions
You might have TBI twice a day for 3 or 4 days, or as a single treatment. For these sessions the radiographers help you to lie or stand in the correct position. This can take up to half an hour. You have treatment for 10 to 15 minutes on both sides of your body.
Having the stem cells
You have your matched donor stem cells (allogeneic transplant) after you finish the high dose treatment. You have these through a drip into your central line or a thin tube in your arm (cannula). It's like having a blood transfusion and usually takes a couple of hours at the most.
The stem cells move through your bloodstream and back into your bone marrow. This helps the bone marrow make healthy blood cells again. You have regular blood tests to check when your bone marrow starts to make new blood cells.
In some hospitals you might have the stem cells in the day care unit rather than as an inpatient on the ward. You are admitted into hospital if you develop side effects. You go to the day care unit every day for blood tests and to check how you are. Having part of your transplant treatment as an outpatient is becoming more common.
Being in isolation
After the high dose treatment you have extremely low numbers of blood cells for some time. This means you are at very high risk of picking up infections.
You are usually in a single room in the hospital ward to help protect you from infection. These rooms have special filters. They help trap bacteria that might be in the air that could cause infection.
You stay in the single room until your bone marrow has started to make blood cells again and your counts have come up. This can take between 2 and 4 weeks.
You can have visitors, but they are sometimes limited to one or two each day. Your family and friends shouldn't see if you if they are unwell or if they have been in contact with anyone with an infectious illness.
Your nurse may suggest that family and friends contact you before visiting to make sure you feel up to it.
Before your visitor enters the room they must wash their hands thoroughly and they might have to wear protective clothing (apron and gloves). They may also have to leave things like coats and bags outside your room during the visit. Your nurse will explain what they need to do.
You might have to follow a special diet including foods that are unlikely to give you an infection.
Staying in a single room in hospital can feel lonely and people often get bored easily. Some people find it frightening. It can help to talk to the nurses about your worries.
Taking in some of your personal things can make the room feel more homely. You can also take in your mobile phone, laptop, tablet or music. This can help the time to pass and you can keep in touch with your friends and family.
Possible side effects of transplants
The side effects of having a stem cell transplant are caused by high dose treatment and radiotherapy. These treatments lower the number of blood cells. Side effects include:
- an increased risk of getting an infection
- tiredness and lack of energy
- increased risk of bleeding
- sickness and diarrhoea
Stem cells from a donor (allogeneic transplant) can cause a reaction called graft versus host disease (GvHD). This happens if the donor's stem cells attack some of your own cells.