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The overall survival rate from leukemia has increased dramatically in recent years, largely due to improvements in treatment.
From 1975 to 2005, 5-year survival increased
Chemotherapy is often used as the primary treatment for leukemia. But the high levels of chemicals in chemotherapy drugs can damage your bone marrow, leading to: low blood cell count, bleeding and serious infections.
A stem cell transplant is a treatment option that replaces damaged stem cells in your bone marrow and allows you to receive a higher dose of chemotherapy.
In this article, we explore how stem cell transplants can help people with leukemia. We also look at costs and effectiveness, but also at where stem cells come from.
A stem cell transplant is also known as a bone marrow transplant. It involves transplanting stem cells into your bone marrow to replace stem cells damaged during chemotherapy and radiation therapy.
Stem cells are the only cells in your body that have the potential to become another cell. Most of the stem cells are found in your body in the bone marrow. Stem cells in your bone marrow become red blood cells, white blood cells, and platelets.
The two main types of transplants are:
- Autologous stem cell transplants. During this transplant, stem cells are collected from your blood or bone. They are then frozen and re-infused into your blood intravenously after you receive chemotherapy and possibly radiation therapy.
- Allogeneic stem cell transplants. In this transplant, stem cells are taken from a donor, placenta or umbilical cord. These cells will be reintroduced into your blood after you receive chemotherapy or radiation therapy.
Many clinics have an upper limit of: 60 or 65 for performing stem cell transplants because younger patients tend to have fewer complications than older patients. However,
Usually, people have the best results when their cancer has not spread to other tissues such as the central nervous system or organs.
Others factors that can make you a good candidate include:
- be in good general health
- have cancer that is unlikely to be treated successfully with chemotherapy alone
- have an available donor
- have a clear understanding of the risks and benefits
Here’s what to expect before, during, and after a stem cell transplant.
Before
Allogeneic Stem Cell Treatment
Before receiving allogeneic stem cell treatment, you will undergo pre-transplant treatment, which usually involves high doses of chemotherapy and sometimes radiation therapy. The goal of these therapies is to kill as many cancer cells as possible.
Autologous Stem Cell Transplant
Before autologous stem cell transplantation, you will be given medications that make your body make more stem cells and move stem cells from your bone marrow to your bone. The stem cells are isolated and frozen until needed. You will then receive a high dose of chemotherapy and possibly radiation.
During the treatment
Allogeneic Stem Cell Treatment
About 2 days upon completion of the pre-transplant treatment, you will receive your stem cell transplant. The stem cells are delivered through a central venous catheter, which is a tube that is inserted into a large vein until it reaches your heart. The stem cells will travel through your bloodstream and eventually reach your bone marrow.
Once there, they will start making new blood cells.
Autologous Stem Cell Transplant
Your frozen stem cells are thawed and put into your body through a large vein. You can get medication in advance.
Some people get tandem transplants where they get stem cells in multiple doses.
recovery
The time it takes for the stem cells to produce a constant amount of blood is usually about 2 to 6 weeks. You will likely stay in the hospital for at least several weeks.
You may be given antibiotics, antiviral drugs, or antifungal medications after the procedure to help prevent infection.
Once you are discharged from the hospital, you will likely still have daily or weekly exams and regular blood tests. It can take as long as 6 to 12 months so that your blood count returns to normal.
Stem cell transplants can cause many possible side effects and complications. Some of these complications can be life-threatening.
You can minimize your chances of serious complications by keeping an open line of communication with your transplant team and alerting them if you have any problems.
Here are some of the possible complications you may face. Many other complications are also possible.
- Ulcers in your mouth. Mouth ulcers are side effects of chemotherapy and radiation therapy. They usually disappear within a few weeks.
- Nausea or vomiting. Chemotherapy drugs often cause nausea or vomiting for up to: 7 to 10 days after your last treatment. Your doctor can give you medicine for nausea.
- Infection. You are at high risk of infection for at least the first 6 weeks after your procedure because of a low white blood cell count. Even infections that normally cause mild symptoms can cause serious complications.
- Bleed. You are at an increased risk of bleeding due to decreased platelets. Platelets are the cells that help your blood clot.
- Lung problems. An infection of your lung tissue is common during the first 100 days after your transplant. Chemotherapy, graft-versus-host disease, and radiation therapy can also lead to pneumonia.
- Graft versus host disease. Graft versus host disease is a possible side effect of an allogeneic transplant. It happens when your body sees the donated stem cells as an invader. It is relatively common, but often disappears once your body gets used to the new cells.
- Graft failure. A graft failure occurs when your body rejects the new stem cells. It is most common when the stem cell donor is not a good match.
- Hepatic veno-occlusive disease. Hepatic veno-occlusive disease is a life-threatening condition that can occur after allogeneic transplants. It occurs when blood vessels in your liver become blocked.
The survival rate after a bone marrow transplant has improved in recent years. Your chances of survival depend on factors such as the type of leukemia you have, your age, and your overall health.
A big study 2019 found that patients with acute lymphoblastic leukemia who received chemotherapy and stem cell transplants had a 39 percent lower risk of death compared with people who received chemotherapy alone.
According to the Canadian Cancer SocietyIf an allogeneic stem cell transplant is performed during the first remission, the 5-year disease-free survival rate is 30 to 50 percent for acute myeloid leukemia. If there is no recurrence within 2 years, there is an 80 percent chance of remaining in remission for a long period of time.
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The cost of a stem cell transplant can vary depending on factors such as the type of procedure and the length of your hospital stay. It’s a good idea to discuss the price for the procedure with your healthcare team to get an idea of what it will cost.
Hospital costs, medications, and outpatient costs can all add up to the total cost. Your insurance may not cover all of these costs.
Medicare Part A and B provide coverage for allogeneic and autologous stem cell treatments. Private insurance can also help to cover the costs. They may not provide coverage if they consider the treatment to be experimental or if they have a list of pre-approved transplant centers.
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This is how the costs are divided:
It’s a good idea to keep detailed records of all your expenses and communicate regularly with your healthcare team to avoid billing surprises.
Stem cells used in an autologous stem cell transplant come from your own bone marrow. They are removed from your body before you undergo chemotherapy.
In allogeneic stem cell transplantation, stem cells come from a donor. They can also come from a donation umbilical cord blood or the placenta of newborn babies. Placentas and cord blood are donated to hospitals by parents.
Often the best donor is a sibling who has the same leukocyte antigen genes. Donors with different tissue types can cause your immune system to attack the stem cells. Only about 25 percent of people who receive a stem cell transplant have the ideal donor.
Doctors collect stem cells by inserting a hollow needle into one of the donor bones to reach the bone marrow. The hip bone is often used.
The National Marrow Donor Program also has a list of potential cell donors if you don’t have a relative who is a match.
Numerous clinical trials are underway to investigate how best to proceed with stem cell transplants to treat leukemia.
Some of the areas that are under investigation include:
- identify who benefits most from autologous versus allogeneic transplants
- the use of lower-intensity chemotherapy and radiation therapy
- Using T-cell infusions for when cancer returns after allogeneic stem cell transplantation
- investigating the effects of tandem stem cell transplants versus single transplants
- determining the potential benefits and risks of stem cell transplants in people over 70 years of age
- monitoring and treatment of recurrent leukemia after stem cell transplants
Stem cell transplants are used to replace stem cells in your bone marrow that are destroyed during chemotherapy and radiation therapy. Stem cell therapy is most commonly used to treat people under the age of 60 or 65, but research is still ongoing on its benefits for older adults.
You can find out with your doctor whether you are a good candidate for a stem cell transplant. They can also walk you through the potential risks and benefits to help you decide if it’s right for you.
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