Your doctor may recommend an allogeneic stem cell transplantation or an autologous stem cell transplantation to treat your acute myeloid leukemia (AML). Stem cell transplantation isn't an option for everyone, especially because of the high, sometimes life-threatening risks associated with it. The question of which patients are likely to benefit from transplantation after their first complete remission is under study in clinical trials.
Studies show that allogeneic stem cell transplantation may benefit high-risk and intermediate-risk patients who are younger than 60 and have a sibling match. Treating with a reduced-intensity transplant has shown some benefit for healthier older patients, up to age 75. There does not seem to be any clear advantage for patients considered favorable or chemo-sensitive. Autologous transplant is being used in some centers as an alternative to multiple cycles of chemotherapy.
Allogeneic Stem Cell Transplantation
Allogeneic stem cell transplantation involves transferring stem cells from a healthy person (the donor) to the patient. The procedure follows high-intensity chemotherapy, potent drugs that must be toxic enough to kill leukemic cells. Unfortunately, the drugs also take aim at normal stem cells in the bone marrow.
The main reasons for doing an allogeneic stem cell transplant are:
- To start a new supply of red cells, white cells and platelets with help from the transplanted donor stem cells
- To give strong doses of chemotherapy to kill AML cells
The decision to do a stem cell transplant depends on:
- The availability of a matched donor
- Your response to oral drug therapy
- Your understanding of the transplant's benefits and risks
Allogeneic stem cell transplantation is used to treat certain AML patients. It is a curative treatment option for some AML patients in first remission. Allogeneic transplantation is associated with a higher rate of side effects and mortality than autologous transplant. However, it may be considered for patients with higher-risk AML, based on cytogenetic and molecular test results. The decision to perform an allogeneic transplant also depends on the age of the patient and the patient’s (or his or her family’s) understanding of the potential benefits and risks. The upper age limit for transplantation varies by treatment center; many centers use age 60 or 65 years for allogeneic transplantation and 70 or 75 years for reduced-intensity allogeneic transplantation.
Reduced-Intensity Allogeneic Stem Cell Transplantation
Reduced-intensity allogeneic stem cell transplantation may be a treatment option for patients who are too old or who may have other medical conditions that prevent them from having a standard allogeneic stem cell transplant. The conditioning therapy used for a reduced-intensity transplant is of lower intensity than that for a standard stem cell transplant; it does not completely inactivate the patient’s immune system or treat the AML as intensively. Thus, if a suitable donor is available, patients up to age 75 may benefit from this form of treatment.
Graft Versus Host Disease
A serious risk of allogeneic and reduced-intensity allogenic stem cell transplantation is graft versus host disease (GVHD), which develops if the donor's immune cells attack your normal tissue. GVHD's effects can range from minor to life threatening.
Autologous Stem Cell Transplantation
Autologous stem cell transplantation involves "harvesting," or retrieving, noncancerous stem cells from the patient’s own body and freezing them. The cells are returned to the patient’s body after receiving intensive chemotherapy. The procedure is only appropriate for certain patients.
The question of which patients are likely to benefit from transplantation after their first complete remission is under study in clinical trials. The decision to do a stem cell transplant depends on whether the patient’s AML is favorable risk, intermediate risk or high risk. The doctor also considers:
- The patient’s overall health
- The chances that chemotherapy alone will cure the AML
- The type of abnormal changes to the chromosomes and cells
- The availability of a matched donor, if necessary
- The patient’s understanding of the benefits and risks of transplant
Autologous transplantation is relatively safe for many patients, including older patients. For some AML patients who do not have an HLA-matched stem cell donor, therapy can be further intensified with very-high-dose chemotherapy followed by an autologous transplant.
- Stem Cell Transplantation
- Managing Side Effects
- Integrative Medicine and Complementary and Alternative Therapies
- Food and Nutrition
- Download or order The Leukemia & Lymphoma Society's free booklet Blood and Marrow Stem Cell Transplantation