Stem cell or bone marrow transplant is a way of giving very high dose chemotherapy. You also sometimes have whole body radiotherapy. It isn't a common treatment for chronic lymphocytic leukaemia (CLL).
When do you have a transplant for CLL?
Bone marrow or stem cell transplants are not a common treatment for CLL. The aim of transplant is to try to cure the leukaemia. Or to control it for longer than is possible with other types of treatment.
Your doctor is most likely to suggest a transplant if:
- you are young and well enough to have intensive treatment
- your leukaemia has come back quite quickly after your initial treatment
What are stem cells and bone marrow?
Bone marrow is a spongy material that fills the bones.
It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.
You have a stem cell or bone marrow transplant after very high doses of chemotherapy. You also sometimes have whole body radiotherapy. The chemotherapy and radiotherapy has a good chance of killing the cancer cells. But it also kills the stem cells in your bone marrow.
For CLL, you usually have a stem cell transplant using stem cells from a donor. This is called an allogeneic transplant.
Having stem cells from a donor
Your donor stem cells
The stem cells of your donor need to be as similar as possible to yours.
The most suitable donor is usually a brother or sister. There is a 1 in 4 chance of a brother or sister being a good match.
It is possible to get a match from a donor who is not a relative. Your doctor will contact one of the registers in the UK to see if there is a suitable donor. This is called a matched unrelated donor (MUD).
Matching donor stem cells
Everyone has their own set of proteins on the surface of their blood cells. The staff in the laboratory compare the surface of your blood cells and the donor blood cells. Your brother or sister are most likely to have similar proteins to you.
The staff check to see how similar the donor cells are to your own. This test is called HLA typing or tissue typing.
The laboratory staff look for proteins called HLA markers and histocompatibility antigens. They check for 10 HLA markers. The result of this test shows how good the HLA match is between you and the donor.
Before your high dose chemotherapy, your team collects a donor's stem cells or bone marrow.
You usually have a high dose of chemotherapy. You might have whole body radiotherapy at the beginning or the end of the chemotherapy.
After the treatment you have the stem cells into a vein through a drip. The cells find their way back to your bone marrow. Then you can make the blood cells you need again. It can take a few days or weeks for the stem cells to start making enough blood cells.
Possible side effects
The main side effects of high dose chemotherapy and transplant include:
- increased risk of getting an infection
- low blood cell counts
- increased risk of bleeding
- a reaction called graft versus host disease - this is when the donor cells attack some of your own body cells