Bone marrow transplant (also called stem cell or hematopoietic cell transplant) may be used to treat people with acute lymphoblastic leukemia (ALL) who are in remission for the first time or whose leukemia recurred and was put back into remission with additional treatment.
In this procedure, 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 previously taken from the patient.
Allogeneic transplants are the most common type used to treat ALL for a couple of reasons.
- After giving you strong doses of chemotherapy to kill the ALL 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.
An allogeneic transplant may be considered if you’re at high risk for relapse or if you relapsed after achieving remission with prior treatment. Transplants are often associated with severe side effects. Depending on the specifics of your disease and your overall health, a transplant with reduced-dose conditioning (rather than typical high-dose conditioning) may be appropriate for you. Reduced-intensity transplants (also called non-myeloablative transplants or mini-transplants) are still intensive, but in some ways they are less intensive than conventional transplants.
Autologous transplants are not used very often for ALL, but they are sometimes used for people who are in remission. In an autologous transplant, your own stem cells are removed, and then they are purged to try to eliminate any leukemic cells before being returned to your body. One reason doctors use this type of transplant less frequently is that it is difficult to separate and eliminate the leukemic cells from your healthy cells, so 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 Hutchinson 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.