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Stem cells are immature cells that are the starter cells for all types of body tissues. A stem cell transplant uses stem cells to replace bone marrow that contains cancer. These stem cells will grow and become new and healthy bone marrow. The bone marrow with cancer is first destroyed with high-dose chemotherapy. Or, this may be done with radiation to the whole body. Healthy stem cells are then put in your body.
This treatment is done less often for chronic myeloid leukemia (CML) than targeted therapy, such as imatinib. But it is still a valuable choice for many people. A doctor may wait and see how you respond to targeted therapy before doing a stem cell transplant.
Although a stem cell transplant may cure you from CML, the benefit has to be weighed against the risks. Risks include dying of complications of the transplant. Your doctor may recommend a stem cell transplant if you’re younger and fairly healthy, and any of these apply to you:
Your CML is in the chronic phase, and targeted therapy is not working. Most people with CML are offered treatment with targeted therapy first. But a stem cell transplant may be offered if targeted therapy doesn’t work or stops working, especially in young people.
Your CML is in the accelerated phase. Targeted therapy doesn’t work as well during the accelerated phase. In these cases, a stem cell transplant may be advised.
Your CML is in the blast phase. Targeted therapy alone is unlikely to work in the blast phase. In these cases, a stem cell transplant may be advised.
There are 2 kinds of stem cell transplants:
Allogeneic transplant. This means the stem cells come from another person whose cell type is almost exactly like yours. This may be a brother or sister.
Autologous transplant. This means the stem cells are collected from your own body and preserved. This is done before you get chemotherapy.
An allogeneic transplant is the only known cure for CML. An allogeneic transplant is also preferred because:
Donor cells cause an immune reaction, which may help to fight the leukemia. Using your own stem cells wouldn’t cause an immune reaction.
If you use your own stem cells (autologous transplant), it’s possible some leukemia cells may still be in the stem cells given back to you after treatment.
From the blood. This is the most common source of stem cells for a transplant. You or your donor may get an injection of a growth factor medicine for several days. This medicine helps stimulate stem-cell production. The process for collecting stem cells from the blood is called apheresis. It’s a lot like giving blood, but it takes longer. A thin, flexible tube (catheter) is used to get blood from your vein or from a donor. The blood goes to a cell separation device to remove the stem cells. The stem cells are then frozen until needed later. Then the extra blood is returned to you or the donor. You may have a strange taste in your mouth during the process. This is from the preservative used to freeze the stem cells. This process may need to be done more than once to collect the right amount of cells.
From the bone marrow. Stem cells may also be taken from the bone marrow of you or the donor. This process is done while you or your donor is asleep with general anesthesia. A doctor makes several punctures in the pelvic or hip bone to remove marrow. Soreness in the hip bone may last for several days. These stem cells are filtered and frozen until they are needed.
You will be admitted to the hospital the day before your transplant. Your doctor or nurse will go over how to keep your gown sterile, how to prepare your food after the transplant, and other ways to help you avoid germs. This is needed to lower your exposure to infections.
After the chemotherapy or radiation therapy is finished, you will receive the stored stem cells through a needle in your arm that’s attached to a tube. This is similar to a blood transfusion.
You will then have to wait for your stem cells to start multiplying. You may have to stay in isolation away from people to avoid getting an infection. Once the part of your white blood cell count (absolute neutrophil count) reaches a safe level, you can come out of isolation and then eventually go home. This may happen within several weeks, or it may take longer.
You will need to have your blood drawn often to check your blood cell count for the next several weeks. This can be done on an outpatient basis.
If you relapse after an allogeneic stem cell transplant, you may have a treatment called donor lymphocyte infusion (DLI). This treatment is done by removing white blood cells called lymphocytes from the stem cell donor’s blood. The lymphocytes are frozen. They are later thawed and given to you in 1 or more infusions. The lymphocytes will then attack your leukemia cells.
A mini-transplant is sometimes used for a person with CML who can’t tolerate a standard stem cell transplant. It’s also called nonmyeloablative transplant. Or it may be called a reduced intensity allogeneic transplant
The treatment is done with a lower dose of chemotherapy or radiation. This doesn't fully destroy the cells in the bone marrow. But it’s enough to suppress the immune system. Then you receive donor stem cells. These stem cells later develop an immune reaction to the leukemia cells and kill them. Because this treatment uses lower doses of chemotherapy or radiation, it often has less severe side effects. Older adults or people with other health problems can often tolerate this treatment better.
Many doctors still consider mini transplants to be experimental for CML and believe that they are best done as part of a clinical trial.
Most of the short-term side effects of a stem cell transplant are from the high doses of chemotherapy or radiation. These should go away as you recover from the transplant. Common side effects can include:
Low blood cell counts
Low blood pressure
Shortness of breath
Chest pain or tightness
Fever or chills
Loss of appetite
Some side effects of a stem cell transplant may be long-lasting or appear years later, such as:
Bone pain, caused from damage due to lack of blood supply (aseptic necrosis)
Growth of another cancer
Shortness of breath, often caused by radiation damage to the lungs
Damage to the liver, kidneys, or other organs
Lack of menstrual periods, which may mean ovary damage and cause infertility
Vision problems caused by damage to the lens of the eye
Weight gain, which may be a sign of thyroid gland damage
Another possible long-term side effect is graft-versus-host disease. This can only occur with an allogeneic transplant. The immune system cells in the donor's stem cells attack your body. The cells can attack your skin, liver, gastrointestinal tract, mouth, or other organs. This can cause symptoms such as:
Skin rashes with itching
Yellowing of the skin (jaundice)
It's important to discuss the procedure with your doctor to make sure you understand the possible risks and benefits.
Stem cell transplant is a complex procedure. It’s only done by doctors with special training. If you decide to have one, go to a hospital that specializes in stem cell transplants, such as a major cancer center. The procedure is also expensive. It can cost more than $100,000. Make sure to check with your insurance provider to see how much of it will be covered.
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