Acute Lymphocytic Leukemia - Treatment During Remission

Highlights	Diagnosis	Treatment After Relapse
Introduction	Prognosis	Transplantation
Causes	Treatment	Home Management
Risk Factors	Treatment to Achieve Remission (Induction Therapy)	Resources
Symptoms	Treatment During Remission (Consolidation and Maintenance)	References

Transplantation

Stem cells that are made in the bone marrow are the early form of all blood cells in the body. They normally mature into red, white, or immune cells. To help the patient survive high dose chemotherapy needed to cure leukemia that has returned treatment, or not responded to treatment, a stem cell transplantation procedure may be used. Stem cell transplantation replaces blood stem cells that were lost during the initial chemotherapy treatment. The lost stem cells are replaced by transplanting them from a donor into the patient.

Types of Donors

The stem cells to be given to the person with leukemia can come from either the patient (autologous ) or a donor(allogeneic ):

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Allogeneic tranplant. In an allogeneic transplant, the stem cells are taken from another person or donor. The immune system of the person receiving the new cells will usually try to reject these new, foreign cells. The more similar genetically the donor cells are, however, the less likely the person receiving the cells will reject them. Allogeneic transplants that are from genetically matched sibling donors offer the best results in ALL. With new techniques, donor bone marrow from unrelated but immunologically similar donors is proving to work as well as those from matched siblings
Autologous transplant. If the marrow or blood cells used are the patient's own, the transplant is called autologous. Autologous transplants in patients with ALL are generally not beneficial, since there is some danger that the cells used may contain tumor cells and the cancer can regrow. Treatment advances that reduce this risk, however, may make autologous transplantation feasible in patients without family donors.

The Blood Stem Cell Collection Procedure

Sources of Cells. Stem cells can be obtained either from the donor’s:

Bone marrow (bone marrow transplantation)
Blood (peripheral blood stem cell transplantation)

The Transplant Procedure

The patient with ALL is given high-dose chemotherapy with or without radiation -- a treatment known as conditioning. The point is to inactivate the immune system and to kill any remaining leukemia cells.
A few days after treatment, the patient is rescued using the stored stem cells, which are administered through a vein. This may take several hours. Patients may experience fever, chills, hives, shortness of breath, or a fall in blood pressure during the procedure.
The patient is kept in a protected environment to minimize infection, and the patient usually needs blood cell replacement and nutritional support.

Side Effects and Complications

Stem-cell transplantation is a serious and complex procedure that can cause many short- and long-term side effects and complications. Early side effects of transplantation are similar to chemotherapy and include nausea, vomiting, fatigue, mouth sores, and loss of appetite. Bleeding because of reduced platelets is a high risk during the first four weeks and may require transfusions. Later side effects include fertility problems (if the ovaries are affected), thyroid gland problems (which can affect metabolism), lung damage (which can cause breathing problems) and bone damage.

Two of the most serious complications of transplantation are infection and graft-versus-host disease: