Stem cell transplant – Leukaemia Care e-learning

A stem cell transplant is performed after the induction chemotherapy to consolidate remission (Holtzer et al 2016). Normally, patients who have a stem cell transplant do not need maintenance chemotherapy.
An allogeneic stem cell transplant (ASCT) is a stem cell transplant from a sibling or matching donor to consolidate their remission. Autologous stem cell transplantations, where the transplanted stem cells are from the patient, are rarely performed.
In addition to performing an ASCT after first remission for the purpose of consolidation, patients who have had two or more remissions may also be candidates for an ASCT.
Before the ASCT, the bone marrow is treated with high-dose chemotherapy to kill the leukaemia cells in the bone marrow which is then ready to receive the healthy stem cells. This is called myeloablative conditioning.
For older or less fit patients, lower doses of chemotherapy without radiation are used to make it easier to tolerate. This is known as reduced-intensity conditioning.
The healthy stem cells are administered intravenously, and migrate to the bone marrow where they form new blood cells to restore the bone marrow.
After the ASCT, the patient will receive drugs to prevent rejection of the donated stem cells. The patient must stay in hospital for 4 to 6 weeks.
While an ASCT can achieve a cure, it does have significant risks for patients such as rejection of the transplanted cells and other life‑threatening complications including bleeding or infections.