The overall survival rate of leukemia has increased greatly in recent years, largely due to improvements in treatment.
Chemotherapy is often used as the primary treatment for leukemia. But the high level of chemicals in chemotherapy drugs can damage your bone marrow, which can lead to low blood cell counts, bleeding, and serious infections.
A stem cell transplant is a treatment option that replaces damaged stem cells in your bone marrow and allows you to receive a higher dose of chemotherapy.
In this article, we examine how stem cell transplants can help people with leukemia. We also look at its cost and effectiveness, as well as where stem cells come from.
A stem cell transplant is also called a bone marrow transplant. It involves transplanting stem cells into your bone marrow to replace stem cells damaged during chemotherapy and radiation therapy.
Stem cells are the only cells in your body that have the potential to become any other cell. Most of the stem cells in your body are found in bone marrow. Stem cells in your bone marrow become red blood cells, white blood cells, and platelets.
The two main types of transplants are:
- Autologous stem cell transplants. During this transplant, stem cells are collected from your blood or bone. They’re then frozen and reinfused into your blood intravenously after you receive chemotherapy and possibly radiation therapy.
- Allogeneic stem cell transplants. During this transplant, stem cells are taken from a donor, placenta, or umbilical cord. These cells will be re-infused into your blood after you receive chemotherapy or radiation therapy.
Many clinics have an upper age limit of 60 or 65 for performing stem cell transplants because younger patients typically have fewer complications than older patients. However,
Typically, people have the best results when their cancer hasn’t spread to other tissues like the central nervous system or organs.
Other factors that may make you a good candidate include:
- being in good overall health
- having cancer unlikely to be successfully treated with only chemotherapy
- having an available donor
- having a clear understanding of the risks and benefits
Here’s what you can expect before, during, and after a stem cell transplant.
Allogeneic stem cell treatment
Before you receive an allogeneic stem cell treatment, you’ll undergo pre-transplant treatment, which usually involves high doses of chemotherapy and sometimes radiation therapy. The goal of these therapies is to kill as many cancer cells as possible.
Autologous stem cell transplantation
Before autologous stem cell transplantation, you’ll receive medications that cause your body to produce more stem cells and move stem cells from your bone marrow to your bone. The stem cells will be isolated and frozen until they’re needed. You’ll then receive a high dose of chemotherapy and possibly radiation therapy.
Allogeneic stem cell treatment
About 2 days after completing pre-transplant treatment, you’ll receive your stem cell transplantation. The stem cells will be delivered through a central venous catheter, a tube inserted into a major vein until it reaches your heart. The stem cells will travel through your bloodstream and eventually reach your bone marrow.
Once there, they’ll start to produce new blood cells.
Autologous stem cell transplantation
Your frozen stem cells will be thawed and infused into your body through a major vein. You may receive medication beforehand.
Some people receive tandem transplants where they receive stem cells in multiple doses.
The time it takes for the stem cells to start producing a steady amount of blood typically takes about 2 to 6 weeks. You’ll likely stay at the hospital for at least several weeks.
Once you’re released from the hospital, you’ll likely still have daily or weekly exams and regular blood tests. It may take as long as 6 to 12 months for your blood count to return to normal.
Stem cell transplants can cause many potential side effects and complications. Some of these complications can be life threatening.
You can minimize your chances of serious complications by keeping an open line of communication with your transplant team and alerting them as soon as you have any problems.
Here are some of the potential complications you may deal with. Many other complications are also possible.
- Sores in your mouth. Mouth sores are side effects of chemotherapy and radiation therapy. They usually go away within a couple of weeks.
- Nausea or vomiting. Chemotherapy drugs commonly cause nausea or vomiting for up to 7 to 10 days after your last treatment. Your doctor may give you anti-nausea drugs.
- Infection. You’re at a high risk for infection during at least the first 6 weeks after your procedure due to low white blood cell levels. Even infections that normally cause mild symptoms can cause severe complications.
- Bleeding. You’re at an increased risk for bleeding due to lowered levels of platelets. Platelets are the cells that help your blood clot.
- Lung problems. An infection of your lung tissue is common during the first 100 days after your transplant. Chemotherapy, graft-versus-host disease, and radiation therapy can also lead to lung inflammation.
- Graft-versus-host disease. Graft versus host disease is a potential side effect of an allogeneic transplant. It happens when your body sees the donated stem cells as an invader. It’s relatively common but often goes away once your body becomes used to the new cells.
- Graft failure. A graft failure occurs when your body rejects the new stem cells. It’s most common when the stem cell donor isn’t a good match.
- Hepatic veno-occlusive disease. Hepatic veno-occlusive disease is a life threatening condition that can occur after allogeneic transplants. It occurs when blood vessels in your liver become blocked.
The survival rate after a bone marrow transplant has improved in recent years. Your chances of survival depend on factors such as the type of leukemia you have, your age, and your overall health.
A large 2019 study found that patients with acute lymphoblastic leukemia who received chemotherapy and stem cell transplant had a 39 percent decreased risk for mortality compared to people who only received chemotherapy.
According to the Canadian Cancer society, if an allogeneic stem cell transplant is performed during first remission, the 5-year disease-free survival rate is 30 to 50 percent for acute myelogenous leukemia. If there’s no reoccurrence within 2 years, there’s an 80 percent chance of staying in remission for a long period.
The cost of a stem cell transplant can vary depending on factors like the type of procedure and the length of your hospital stay. It’s a good idea to discuss the price with your healthcare team before the procedure to get an idea of what it will cost.
Hospital fees, medications, and outpatient costs can all contribute to the overall cost. Your insurance may not cover all of these expenses.
Medicare part A and B provide coverage for allogeneic and autologous stem cell treatments. Private insurances may also help cover costs. They may not provide coverage if they see the treatment as experimental or if they have a list of pre-approved transplant centers.
Here’s how the costs broke down:
It’s a good idea to keep detailed notes of all your expenses and communicate regularly with your healthcare team to avoid billing surprises.
Stem cells used during an autologous stem cell transplant come from your own bone marrow. They’re extracted from your body before you undergo chemotherapy.
In allogeneic stem cell transplant, stem cells come from a donor. They can also come from donated umbilical cord blood or the placenta of newborn babies. Placentas and umbilical cord blood are donated to hospitals by parents.
Often, the best donor is a sibling who has the same leukocyte antigen genes. Donors who have different tissue types may cause your immune system to attack the stem cells. Only about 25 percent of people who receive a stem cell transplant have the ideal donor.
Doctors collect stem cells by inserting a hollow needle into one of the donor’s bones to reach the bone marrow. Often the hipbone is used.
The National Marrow Donor Program also has a list of potential cell donors if you don’t have a family member who is a match.
Countless clinical trials are underway examining how to best you stem cell transplants to treat leukemia.
Some of the areas being explored include:
- identifying who’s most likely to benefit from autologous versus allogeneic transplants
- using lower-intensity chemotherapy and radiation therapy
- using T cell infusions for when cancer returns after allogeneic stem cell transplant
- examining the effects of tandem stem cell transplants versus single transplants
- determining the potential benefits and risks of stem cell transplants in people over the age of 70
- monitoring and treating relapsed leukemia after stem cell transplants
Stem cell transplants are used to replace stem cells in your bone marrow that are destroyed during chemotherapy and radiation therapy. Stem cell therapy is usually used to treat people under the age of 60 or 65, but studies are continuing to examine the benefits for older adults.
You can find out if you’re a good candidate for a stem cell transplant by talking to your doctor. They can also walk you through the potential risks and benefits to help you decide if it’s right for you.