What Happens During a Stem Cell Transplant for Acute Lymphocytic Leukemia (ALL)
Stem cell transplants may be autologous, which means the stem cells come from your own body. Or they may be allogeneic, which means the stem cells come from a donor. Doctors often prefer to do an allogeneic transplant if a suitable stem cell donor can be found. If not, an autologous transplant may be an option. However, there is also concern that the stem cells from your own body could be contaminated with leukemia cells, even after treatment in a lab. Discuss the risks and benefits with your doctor. It's often best to wait for an induced remission and for the chemotherapy side effects to wear off before proceeding, if possible. Here's a general description of how doctors do a stem cell transplant.
Retrieving the Needed Stem Cells
First, your doctor may remove stem cells from either your bone marrow or that of your donor. You or the donor receives general anesthesia. A doctor makes several punctures in the pelvic (hip) bone to remove marrow. These stem cells are filtered and frozen until needed later. Soreness may last for several days.
In an alternative procedure, called apheresis, you (or your donor) will receive a growth factor drug by injection for several days. This drug helps stimulate stem cells to enter the blood. Then a small tube, called a catheter, is used to obtain blood from your vein or that of the donor. This is similar to donating blood, but takes several hours. The blood goes to a cell separation device to remove the stem cells needed. Then the extra blood is returned to you or the donor. You may need to have this process repeated more than once. This procedure is now more common than taking stem cells directly from the bone marrow.
Receiving the Transplant
You are admitted to the hospital the day before your transplant. Your doctor goes over how to keep your gown sterile and how to prepare your food after the transplant, so that you can lower your exposure to infections.
After the chemotherapy or radiation therapy is finished, you receive the stored stem cells through a needle in your arm that's attached to a tube. This is similar to a blood transfusion.
You then wait for your stem cells to start multiplying. You may need to remain in isolation to prevent infections. Once the part of your white blood cell count known as the ANC reaches 500, you can come out of isolation. Once it reaches 1,000, you may be able to return home. This may happen within 3 to 6 weeks, or it may take longer.
You will need to have a standard tube of blood withdrawn daily to monitor your blood cell count for the next several weeks. You can often do this on an outpatient basis.