Acute myeloid leukemia (AML) is a blood cancer that occurs when too many immature white blood cells are made in your bone marrow. AML is typically treated with chemotherapy, radiation, and stem cell transplants.
Not everyone with AML may be eligible for a stem cell transplant. There are some risks and complications that you should be aware of before deciding to undergo a transplant.
Stem cell transplants are also called bone marrow transplants. They’re used as a treatment for cancers such as AML that destroy healthy bone marrow cells.
Stem cell transplants start with a very high dose of chemotherapy that kills cancer cells and the surrounding stem cells. The dose is strong enough to keep cancer cells from coming back and to keep your bone marrow from growing new normal cells. Radiation might be used along with chemotherapy in some cases.
After the treatment, healthy stem cells can be transplanted into your bone marrow to replace the cells that have been destroyed. Your body can use these cells to grow cancer-free blood cells. These new cells will work and reproduce as expected in your body.
There are two primary types of stem cell transplants:
- Allogeneic: a transplant of stem cells you receive from a donor (most common type)
- Autologous: a transplant of stem cells you receive from yourself
Allogeneic stem cell transplants for AML
An allogeneic stem cell transplant uses donor stem cells from someone with a tissue type that closely matches your own.
Often, the best donor match is a sibling or other close relative, but cells from volunteer-matched unrelated donors can also be used. Your transplant team will let you know how closely your donor matches and whether there’s a risk for complications.
Allogeneic transplants provide the benefit of immune cells from the donor. These donated immune cells can help attack and destroy any remaining cancer cells in your body.
But these new immune cells might also see your entire body as a foreign invader and begin attacking healthy tissue. This is known as Graft-vs-Host Disease (GvHD). It’s one of the most serious potential risks of an allogeneic stem cell transplant.
Autologous stem cell transplant for AML
An autologous stem cell transplant uses your own stem cells. Here’s how it works:
- The cells are removed from your bone marrow and then frozen while you undergo the high-dose chemotherapy treatment.
- Your frozen cells are processed to remove any AML cells.
- Your processed cells are then transplanted back into your bloodstream.
Autologous stem cell transplants can be used if you cannot find a match for an allogeneic transplant. Because the cells you’ll be receiving are your own, there’s a lower risk of complications than what is often seen in allogeneic transplants.
But processing the stem cells does not always remove all remaining cancer cells. The risk with an autologous stem cell transplant is that cancer cells could be transplanted back into your body.
You’ll likely have several tests before receiving a stem cell transplant to help the transplant team determine if you’re a good candidate for this procedure. You’ll also likely meet with social workers and therapists to help you prepare.
Many steps in a stem cell transplant are the same for allogeneic and autologous transplants. But an allogenic transplant will start by locating a donor match. An autologous transplant begins by removing your stem cells.
Other procedure steps can begin once stem cells from a donor or your own blood are ready. This will include the following:
- Inserting a central venous catheter (CVC). If you do not already have a CVC, a medical expert may insert one into a vein in your chest or upper arm before your transplant to help make your chemotherapy and stem cell infusions much easier.
- Receiving high-dose chemotherapy. You’ll receive high-dose chemotherapy to prepare your body for the transplants. Radiation might also be used. The exact dose of chemotherapy depends on your transplant type and overall health.
- Receiving an infusion of stem cells. Stem cells will be infused into your body through the CVC.
It can take 2 to 6 weeks for your new stem cells to begin growing and reproducing inside your bloodstream in a process called engraftment.
You might stay in the hospital during this time or make daily visits to a transplant center. You’ll have lab work done to measure and monitor your blood counts.
Some possible side effects you can experience during this process include:
It can take a year or more to feel fully recovered from a stem cell transplant. You might continue to:
- feel tired
- have trouble exercising
- have trouble concentrating
- experience memory loss
- have a decreased interest in sex
- feel depressed or anxious
- experience changes to your self-image
There are several possible risks of a stem cell transplant.
One of the most serious risks is GVHD. This only occurs after allogeneic transplants and happens when the donor cells attack your body after the transplant.
GVHD can be acute or chronic. It can be mild in some people and life threatening in others. The exact symptoms of GVHD can vary and will depend on the severity and type.
Other possible risks include:
- concerns about your liver, kidneys, heart, or lungs functioning
- loss of thyroid function
Doctors and transplant teams will monitor you for GVHD and other possible complications. It’s important to let them know about any symptoms you might be having. Treatment can help manage any complications that might occur.
Stem cell transplants are a treatment option for AML to replace bone stem cells that have been destroyed by AML.
Transplants can help some people achieve remission. Talk with a doctor to learn more and see if you’re a candidate for this type of treatment.