Autologous (self) stem cell transplant for Leukemia

Overview
Stem cell transplant is sometimes used to treat people with leukemia. The majority of people with leukemia who undergo stem cell transplant receive an allogeneic stem cell transplant, which means that the stem cells are harvested from a donor who may be a sibling or other close blood relative of the recipient or an unrelated person who is a good genetic match. Less commonly, an autologous stem cell transplant (ASCT) may be considered. In an autologous stem cell transplant, the stem cells are harvested from the person’s own body.

The purpose of an autologous stem cell transplant in leukemia is to compensate for higher doses of chemotherapy that will destroy bone marrow. The transplanted stem cells will form healthy bone marrow, replacing the destroyed cells after chemotherapy is complete. In some people, ASCT can help cure leukemia. Because some leukemia cells are likely to be transplanted along with healthy cells, ASCT can also raise the risk for relapse.

Autologous stem cell transplants are sometimes used to treat acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). ASCT may be considered in cases where other treatments are ineffective and the person with leukemia is not a good candidate for allogeneic stem cell transplant, which can cause life-threatening side effects. ASCT may be used when a closely matched donor for allogeneic stem cell transplant is not available.

What does it involve?
Most people with leukemia undergo a course of chemotherapy prior to receiving a stem cell transplant.

Peripheral blood stem cells are harvested before chemotherapy or early in the cycle of chemotherapy. The cells are then stored frozen until they are needed for the autologous stem cell transplant.

Stem cell transplants may be administered early – as soon as 24 hours after chemotherapy is complete – or reserved for later use until a relapse occurs. The process of receiving a stem cell transplant is similar to receiving a blood transfusion. Stem cell transplants for leukemia may be administered on an outpatient or inpatient basis. The majority of people will be admitted to the hospital during the stem cell transplant process. Those admitted to the hospital for stem cell transplant can expect to stay two to three weeks during recovery.

During the first weeks of recovery from stem cell transplant, people with leukemia may receive antibiotics and antiviral or antifungal medications to help protect them against infection. They may also require transfusions of red blood cells or platelets (cell fragments involved in the clotting process) to replace those destroyed by chemotherapy. Those who have undergone stem cell transplant for leukemia may also be given hematopoietic growth factors – substances that encourage and speed the growth of blood cells.

After receiving a stem cell transplant, most people with leukemia will receive maintenance medications to sustain the treatment response.

Intended Outcomes
Stem cell transplant can extend survival and provide a cure in some people diagnosed with leukemia.

Results
Multiple studies have found that people with ALL who were treated with ASCT had a five-year disease-free survival rate of approximately 30 percent, compared with approximately 50 percent for those treated with allogeneic stem cell transplant. In one study, the rate of relapse was 61 percent in those who received chemotherapy and ASCT compared with 23 percent in those who received chemotherapy and allogeneic stem cell transplant.

One clinical trial investigated the use of ASCT for AML that has relapsed after initial complete remission. Reported cure rates for relapsed AML using ASCT range from 25 to 50 percent.

Constraints
Short-term side effects of stem cell transplant can include fatigue, headaches, fever and chills, nausea, vomiting, diarrhea, loss of appetite, weight loss, trouble sleeping, and skin rashes. Some people develop mucositis, inflammation of the digestive tract that can cause pain and make it difficult to eat. Some side effects, such as nausea, can be eased with other medications. Fatigue may be longer-lasting, persisting beyond the immediate recovery period. It may take months to fully recover after receiving a stem cell transplant.

In some people, leukemia fails to respond to stem cell transplant and begins to progress soon after the transplant.

Stem cells harvested during a leukemia relapse or after undergoing allogeneic stem cell transplant may not be viable for use in autologous stem cell transplant. For this reason, doctors may recommend harvesting stem cells during remission or before allogeneic stem cell transplant and storing them to keep ASCT as an option in the future.

For more details about this treatment, visit:

ALL: Stem Cell Transplantation – Leukemia & Lymphoma Society
http://www.lls.org/leukemia/acute-lymphoblastic...

AML: Stem Cell Transplantation – Leukemia & Lymphoma Society
https://www.lls.org/leukemia/acute-myeloid-leuk...

Allo: ALL – Texas Oncology
https://www.texasoncology.com/cancer-treatment/...

Stem Cell Transplantation – Leukemia & Lymphoma Society
https://www.lls.org/treatment/types-of-treatmen...

What are the Side Effects of a Stem Cell Transplant? – Dana-Farber Cancer Institute https://blog.dana-farber.org/insight/2018/02/si...