Bone marrow transplant (also called stem cell or hematopoietic cell transplant) may be used to treat people with acute myeloid leukemia (AML). The two main factors doctors consider when deciding whether you should have a transplant are the likelihood that standard treatment without transplant will be successful and the risk related to the transplant itself. Researchers at Fred Hutch, one of the founding organizations of Seattle Cancer Care Alliance (SCCA), have developed a comorbidity index, used worldwide, that determines transplant risk. Transplants are most effective when AML is in remission.
In a bone marrow transplant, chemotherapy with or without radiation is used to destroy the diseased bone marrow. This is called conditioning. Then stem cells are infused into the patient’s bloodstream (transplanted) to replenish the bone marrow with healthy cells.
There are two main types of transplants: allogeneic and autologous. An allogeneic transplant uses stem cells taken from a donor; an autologous transplant uses stem cells taken from the patient once he or she is in remission.
Allogeneic transplants are the most common type used to treat AML for a couple of reasons.
- After giving you strong doses of chemotherapy to kill the AML cells in your body, doctors can use healthy stem cells from your donor to restart your body’s ability to form blood cells.
- White blood cells from the donor may recognize as foreign and attack any leukemia cells that remain in your body, called a graft-versus-leukemia effect or graft-versus-tumor effect. This effect does not occur with an autologous transplant.
Reduced-intensity transplants (also called nonmyeloablative transplants), which use lower-dose conditioning, as well as transplants that use stem cells from cord blood or haploidentical (half-matched) donors, have increased the number of people eligible for allogeneic transplants.
Autologous transplants are used much less frequently than allogeneic transplants for people with AML. In this procedure, your own stem cells are removed when you are in remission, and then they are purged to try to eliminate any leukemic cells before being returned to your body. Reasons autologous transplants are used less frequently include the lack of a graft-versus-leukemia effect and the difficulty of separating and eliminating the leukemic cells from your healthy cells, meaning there is a risk of returning some leukemic cells to you.
If your condition requires a bone marrow transplant, you should know that the Fred Hutch Bone Marrow Transplant Program at SCCA consistently ranks among the country’s top transplant centers, and our doctors have performed more transplants than any other institution in the world. Learn more about bone marrow transplants, including the different kinds of transplants and the process for getting a transplant here.