If a person has a more advanced form of chronic myelogenous leukemia (CML) that has not gone into remission after treatment with targeted chemotherapy drugs, an NYU Langone hematologist–oncologist may recommend a stem cell transplant. Also known as a bone marrow transplant, the procedure is usually an option for people up to age 75 who are otherwise healthy.
A stem cell transplant is the only treatment that can cure CML, but it does have risks and serious side effects. In stem cell transplantation, a doctor delivers a high-dose chemotherapy drug through a vein with intravenous (IV) infusion for a period of days. This intense treatment destroys cancerous stem cells, which are immature blood cells located in the bone marrow.
Because they also destroy normal stem cells, these cells are then replaced with healthy stem cells provided by a donor. This is called an allogeneic stem cell transplantation. At NYU Langone, the procedure is performed at the Rita J. and Stanley H. Kaplan Stem Cell and Bone Marrow Transplant Center.
Finding a Donor
An allogeneic stem cell transplant requires a donation of stem cells from a healthy person who is considered a “match.” This means the person’s genetic makeup and tissue types are compatible with yours. Siblings are usually ideal matches.
If necessary, an NYU Langone doctor can help locate an unrelated match or matches using national bone marrow registries. It can take several weeks or months to find the appropriate donor or donors.
Stem Cell Collection and Transplantation
After your doctor determines that donor cells are a good match, he or she collects stem cells from the donor. In a peripheral blood stem cell harvest, the doctor collects blood from the donor through a catheter, or hollow tube, that’s inserted into a vein in the arm. The stem cells are either infused into your body that day or frozen and stored for future use. The donor can go home the same day.
Less often, stem cells are collected from bone marrow. In a bone marrow retrieval surgery, the doctor inserts a hollow needle into the donor’s hip bone and withdraws the stem cells directly from the bone marrow. More than one insertion is required to obtain an adequate number of bone marrow cells. The procedure takes place in the hospital, and the donor can usually go home the same day.
You are given the healthy stem cells through a vein with IV infusion in the hospital. Ideally, the cells enter the bone marrow and develop into healthy white blood cells, which help fight and destroy leukemia cells in your body.
After the infusion, your doctor watches for signs that the donated stem cells are making new, healthy blood cells. You may spend several weeks in the hospital during the transplantation process.
Recovery from Stem Cell Transplantation
The chemotherapy you receive causes the levels of both abnormal and normal white and red blood cells and platelets to drop in the days following the stem cell transplant, so your risk of infection and bleeding increases. As a result, you stay in a hospital isolation room, and doctors and specialists monitor you closely.
Usually, your doctor prescribes IV antibiotics to prevent or treat infections. He or she also gives medications to prevent graft-versus-host disease, which occurs when the donated cells attack healthy tissue in your body.
You may also need red blood cell and platelet transfusions until the donor’s stem cells start multiplying in your body. You can expect to stay in the hospital for about four weeks while the stem cells start producing new blood cells. Your doctor monitors you for side effects, including infection and graft-versus-host-disease.
You may return home when your blood cell levels return to normal and your doctor determines you are healthy enough.
Full recovery from a stem cell transplant can take several months. During this time, you have frequent follow-up appointments, and doctors perform blood tests to determine the success of the transplant.
Long-term side effects may include infertility, because cancer treatments can affect levels of sperm in men and hormones necessary for pregnancy in women. Your doctor can discuss fertility-sparing treatment options with you or refer you to specialists at NYU Langone’s Fertility Center.
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