High-dose treatment and stem cell transplants for acute myeloid leukaemia (AML)
Having high-dose treatment and a stem cell transplant allows you to have much higher doses of chemotherapy than usual. This may help to improve the chances of curing the leukaemia, or prolonging a remission.
This involves having very high doses of chemotherapy and sometimes radiotherapy over a few days. High-dose treatment is usually used after initial chemotherapy treatment.
As well as destroying any leukaemia cells, the high-dose treatment also destroys the healthy stem cells in the bone marrow. Stem cells are blood cells in the very earliest stage of development. They develop into the different types of blood cell.
To help you recover from the high-dose treatment, you’ll be given a drip (infusion) of stem cells after it. The stem cells find their way to the bone marrow where they start producing new blood cells.
The stem cells can either be donated by someone else (allogeneic transplant) or you can use your own (autologous transplant). People with AML are more likely to have an allogeneic transplant than an autologous transplant.
Stem cell transplants may benefit a number of people with AML, but they may not be suitable for everyone. If your specialist thinks high-dose treatment and a stem cell transplant is necessary or an option for you, they will discuss it with you in detail.
Allogeneic stem cell transplants
Most people with AML who have high-dose treatment will be given stem cells from a donor. This type of transplant is called an allogeneic stem cell transplant. The donor will usually be a sibling (your brother or sister). Sometimes the donor may not be related but is still a ‘close match’. This is called a matched unrelated donor (MUD) transplant. It’s also sometimes possible to collect donor stem cells from umbilical cord blood. This is blood taken from umbilical cords and stored in a cord blood bank.
Donor stem cells contain healthy immune cells, which attack any leukaemia cells that might still be there.
After you’ve been given the high-dose treatment, the donor stem cells are given to you through a drip (intravenous infusion) using your central line, PICC line or implantable port.
Autologous stem cell transplant
A transfusion of your own stem cells can also be done, although this is less commonly used. This is called high-dose treatment with stem cell support, or an autologus stem cell transplant. If you have APL that has come back after treatment, you may have an autologous stem cell transplant.
Before you have high-dose treatment, some of your stem cells will be collected from your blood. You can have this done as an outpatient. The stem cells are then stored and after you’ve had the high-dose treatment, they’re given back to you through a drip using your central line, PICC line or implantable port.
Bone marrow transplants
Bone marrow transplants are similar to stem cell transplants. Instead of taking stem cells from the blood, some of your own or your donor’s bone marrow is collected. The liquid bone marrow contains stem cells that can be given to you in a drip after you’ve had the high-dose treatment.
We have more detailed information about allogeneic (donor) stem-cell transplants and autologous stem cell transplants.
After a transplant
‘My husband had a room to himself, so we took pictures of key family members and blue tacked them to a picture already on the wall. We also stuck all of his cards to the door for him to see.’
After any type of transplant, the new stem cells take a few weeks to settle in your bone marrow and produce the blood cells you need. During this time, you’ll have very low immunity. You’ll probably need to stay in hospital and be nursed in a single room for a few weeks. This is done to reduce your risk of infection until your white blood cell count has recovered.
Stem cell and bone marrow transplants carry some risk, and are always carried out in specialised treatment hospitals. You may have to be treated at a hospital some distance from your home.