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What Happens During a Stem Cell Transplant for Acute Lymphocytic Leukemia

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 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 the transplant, if possible. The following is 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 your pelvic (hip) bone to remove marrow. These stem cells are filtered and frozen until needed later. You may be sore 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 in the bone marrow to enter the blood. Then your  doctor will use a small tube, called a catheter, to obtain blood from your vein or that of your donor. This is similar to donating blood, but takes several hours. The blood goes to a cell separation device to remove the stem cells. 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 days or a week before your transplant to receive preparative chemotherapy or radiation treatment. Your doctor or nurse will talk to you and your caregivers about the risks of the procedure and will discuss how you can lower your exposure to infections.

After your doctor gives you chemotherapy or radiation therapy, you will receive the stored stem cells through a needle that's attached to a catheter (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 infection. Once the part of your white blood cell count known as the ANC (absolute neutrophil count) reaches 500, you can come out of isolation. Once it reaches 1,000, you may be able to return home. This may happen within a few 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.