Stem Cell Transplantation for Acute Myeloid Leukemia in Adults
Doctors at the Blood and Marrow Transplant Program, part of NYU Langone’s Perlmutter Cancer Center, perform a stem cell transplant, also known as a bone marrow transplant. Bone marrow transplants, which are performed at the Rita J. and Stanley H. Kaplan Blood and Marrow Transplant and Cell Therapy Center, are a treatment option for people who are at a high risk for a relapse, or return, of acute myeloid leukemia (AML).
Your doctor determines your risk of relapse when he or she identifies the type of leukemia through laboratory tests. The risk is based on whether the cancer cells have certain genetic mutations, if you’ve had a blood cancer before, and whether you’ve had chemotherapy for other cancers.
At NYU Langone, stem cell transplantation occurs during the consolidation phase of chemotherapy for AML. During consolidation, your doctor delivers high-dose chemotherapy through a vein with intravenous (IV) infusion for several days. This helps destroy the cancer cells, but it also kills healthy immature blood cells called stem cells.
In stem cell transplantation, the cancerous cells and stem cells are replaced with healthy stem cells provided by a donor. This is called an allogeneic transplant.
Some people at high risk for relapse may receive an allogeneic stem cell transplant instead of consolidation treatment. Doctors may also recommend stem cell transplantation for people who relapse after finishing consolidation.
Sometimes doctors at NYU Langone are able to use lower doses of chemotherapy for an allogeneic stem cell transplant to help reduce the risk of side effects. Although these doses don’t kill all of the leukemia cells in the bone marrow, the donated healthy stem cells can help fight cancer cells in the body.
Radiation therapy is sometimes used with high-dose chemotherapy during stem cell transplantation. Radiation therapy delivers energy beams to destroy residual cancer cells throughout the body.
You may spend several weeks in the hospital during stem cell transplantation.
Finding a Stem Cell Donor
An allogeneic stem cell transplant requires a donation of bone marrow stem cells from a healthy person who is a “match.” This means the person’s genetic makeup and tissue types are compatible with your own. Siblings are frequently the best matches, but other family members may also be good candidates. If necessary, NYU Langone specialists can help you locate an unrelated donor using national bone marrow registries.
It can take weeks to months to find the appropriate donor or donors and perform the necessary testing. Your doctors may recommend an additional cycle of chemotherapy until the search is complete, especially if it takes longer than anticipated.
Stem Cell Collection and Transplantation
After a donor match is made, your doctor collects, or harvests, stem cells from the person. This can be done with a peripheral blood stem cell harvest, in which blood is collected from the donor in the hospital and stem cells are infused on the same day. Sometimes, the cells are frozen for use at a later date.
A doctor can also collect stem cells through bone marrow retrieval surgery, in which the cells are taken after inserting a needle into the donor’s hip bone. More than one insertion is required, and local anesthesia is used.
Your doctor gives you the stem cells through a vein with IV infusion while you’re in the hospital. He or she then watches for signs that the donated stem cells are making new, healthy blood cells in your body.
Recovery from Stem Cell Transplantation
In the first days of a stem cell transplant, your blood cell levels drop, making you vulnerable to infections and bleeding. Your doctors monitor you closely in an isolation room at NYU Langone for about four weeks.
During this time, you receive antibiotics to prevent or treat infection and transfusions of red blood cells and platelets to manage bleeding. Your doctor also prescribes medications to prevent graft-versus-host disease, which occurs when the donated cells attack healthy tissues in your body. He or she manages any other side effects that you may experience and takes steps to prevent them from worsening.
Long-term side effects of stem cell transplantation may include infertility in people of childbearing age. This is because certain chemotherapy drugs can reduce levels of sperm, damage ovaries, induce menopause, and reduce hormone levels necessary for pregnancy. If you are interested in preserving your fertility, your doctor can refer you to NYU Langone’s Fertility Center or NYU Langone Reproductive Specialists of New York for a consultation.
NYU Langone also offers support services, which provide physical and psychological assistance to people who have had stem cell transplants.
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