Overview

Stem cell transplant for leukaemia is one of the most advanced treatments available today. It offers hope for many when standard therapies may not be enough. If you’re searching for a clear and trustworthy explanation, you’re in the right place. This article will provide a comprehensive overview of leukaemia in simple terms, covering the types of transplants, the procedure involved, associated risks, recovery, and the challenges of everyday life after the procedure.

What is leukaemia?

Leukaemia (pronounced loo-KEE-mee-uh) is a type of blood cancer that affects normal blood cell production within the bone marrow. It occurs when an abnormal change happens to developing white blood cells (leukocytes).¹ These abnormal cells, known as leukemic Stem cells(LSCs), multiply uncontrollably and suppress the production of normal cells in the bone marrow. As a result, there is a decrease in the number of healthy red blood cells (RBCs), white blood cells (WBCs), and platelets in the body.²

The four subtypes of leukaemia are:

• Acute Lymphocytic Leukaemia (ALL)
• Acute Myeloid Leukaemia (AML)
• Chronic Lymphocytic Leukaemia (CLL)
• Chronic Myeloid Leukaemia (CML)

Leukaemia can also be classified as acute or chronic based on how fast the abnormal cells multiply and spread. And as myelocytic or lymphocytic, based on the type of blood cell that becomes cancerous.¹

The treatment method depends on the type of leukaemia and other patient-related factors like age, overall health, and other medical conditions.

What is a stem cell?

Bone marrow is a soft, gelatinous tissue present inside your bones. It is like a production factory, where healthy blood cells like RBC, WBC, and platelets are produced. Inside the bone marrow, there are special cells called Hematopoietic stem cells (HSCs) that develop into different types of blood cells (myeloid cells and lymphoid cells).³

• The myeloid cells mature into RBC, Platelets, basophils, eosinophils, neutrophils, and monocytes
• The lymphoid cells mature into lymphocytes and natural killer cells

Stem cells can renew and multiply themselves, and they can also develop into different types of cells with specific functions.⁴ These characteristics allow stem cells to be used effectively in restoring damaged or impaired blood cells in leukaemia.

What is a stem cell transplant?

Stem cell transplantation is a procedure where healthy stem cells are transferred to the patient’s body to replace unhealthy cells in the bone marrow.

Before this procedure, patients with leukaemia will undergo high-dose chemotherapy or radiation therapy to destroy their cancerous blood-forming cells. The healthy stem cells introduced through transplantation will then help in the production of new blood cells.

Types of stem cell transplants

• Autologous transplant: stem cells are collected from your own body, treated to remove any cancer cells, and then reinfused
• Allogeneic transplant: stem cells are taken from a donor. The donor could be a relative or an unrelated person whose cells are a close match to yours
• Syngeneic transplant: stem cells are collected from your identical twin

Other variations

• Mini-transplants: This is a type of allogeneic transplant, where the patient will receive low-dose chemotherapy or radiation compared to the standard transplantation procedure. This process doesn’t kill all your cancer cells, but prevents the rejection of donor stem cells by suppressing your immune system. Recommended for older people and those with a weaker body who cannot tolerate standard high-dose chemotherapy
• Tandem transplants: This is a type of autologous transplant, where the patient will receive high-dose chemotherapy followed by stem cell transplantation. Then, after a few weeks or months, the same step is repeated again

Who can benefit from a stem cell transplant?

Your healthcare provider will decide whether you need a stem cell transplant by assessing various factors, like:

• Type and stage of leukaemia
• Age and overall health status
• Response to other leukaemia treatments
• Tolerance to high-dose chemotherapy/radiation
• Donor availability, or the possibility of using your own stem cells for transplant
• Presence of any other serious health condition.

Stages of the transplant process:

Pre-transplant evaluation:

Several tests and procedures, such as blood tests, CT / PET scans, heart, lung, kidney function tests, bone density, bone marrow biopsy, and dental checks, are performed to check your overall health before the transplant.

Stem cell harvesting:

In an autologous transplant, the stem cells are collected from your own blood. In an Allogeneic transplant, stem cells are taken from a donor from sources such as bone marrow, peripheral blood, or umbilical cord blood.

Conditioning therapy:

Before the transplant, you will receive high-dose chemotherapy and/or radiation to remove the damaged bone marrow, kill all the leukaemia cells and create space for the new donor cells. This process helps suppress your immune system to avoid donor cell rejection.

Stem cell infusion:

Similar to a blood transfusion, you will receive the collected stem cells through intravenous (IV) infusion. The infusion usually takes about 1-5 hours to complete.

Engraftment:

After the transfusion, the transplanted stem cells travel to your bone marrow and start to produce new healthy blood cells. This is called engraftment, and it usually occurs within 10-28 days after the infusion. During this time, your healthcare provider will monitor you closely for signs of infection, bleeding risks, and other complications.

Recovery and follow-up:

Your healthcare provider will continue to perform regular check-ups to monitor your progress, manage side effects, and detect any signs of relapse. During this time, you may need additional blood transfusions, antibiotics, and other supportive treatments. Even after your blood counts return to normal, it may take much longer for your immune system to fully recover.

Risks and side effects of stem cell transplant for leukaemia

Main risks of stem cell transplant

These risks come from the destruction of bone marrow by conditioning therapy you received before the transplant to kill the cancer cells. Until your body starts making healthy blood cells again, you may face:

• Risk of Infections - due to low WBCs and immune system suppression
• Fatigue and anaemia - due to low RBCs, may need blood transfusions
• Risk of Bleeding or bruising - due to low platelet count, may require platelet transfusions

Short-term side effects:

These are usually side effects related to chemotherapy/ radiation. Most of them are temporary and get resolved after some time. Common side effects include:

• Diarrhea
• Mouth ulcers
• Loss of appetite/ difficulty eating and drinking
• Extreme tiredness or exhaustion
• Nausea and vomiting
• Hair loss
• Skin changes (such as rashes)

Late or long-term risks:

• ​​Heart problems
• Lung problems
• Hormone-related issues
• Infertility
• Bone and muscle problems
• Kidney disease
• Cataracts
• Increased risk of developing another type of cancer⁵

These long-term side effects are different for each person. Some side effects are more common, while others may only occur in a few people. Your exact experience will depend on your age, overall health status, type of transplant, and pre-transplant chemo or radiation treatments you received.⁶ 

Graft-versus-host disease (GVHD)

In an allogeneic transplant, the donor’s stem cells see cells in your body as foreign and attack them. This can lead to damage to your skin, liver, intestines, and other organs.

Two types are:

• Acute GVHD – this happens within the first 3 months after transplant
• Chronic GVHD – this occurs 3 months after a transplant

Treatment: Steroids and other medicines that suppress your immune system are administered to control GVHD.

Recovery and life after transplant

Depending on the type of transplant, your recovery time may vary. It usually takes a few months to recover from an autologous transplant, while an allogeneic transplant may take up to 1–2 years. For the first 100 days, you’ll need to stay in or near the hospital so that your healthcare team can closely monitor you for any complications.

Simple daily habits to support your health after transplant

Infection prevention:

• Always wear masks and avoid going to crowded places
• Practice proper hygiene at all times, including regular handwashing, showering, and proper mouth care
• Keeping distance from people who have a cold, the flu, chickenpox, or other viral infections
• Avoid contact with people who have recently received live vaccines, like polio
• Always wash your hands after touching your pets and avoid contact with their litter or waste
• Avoid direct contact with garden soil or potting mix, as soil has moulds and fungi that can cause infections
• Your skin will be more sensitive after the transplant, so use protective clothing to avoid injuries to your skin. Use mild soaps, shampoo, and apply moisturiser to prevent dry skin

Exercise: 

Start with easy exercises to slowly rebuild strength. Your physical therapist can help you choose the types of exercise that are best for you.⁷

Nutrition:

• Eat fruits and vegetables that are washed thoroughly
• Avoid raw or undercooked meat and seafood
• Choose safe, pasteurised foods like milk, eggs, yoghurt, cottage cheese, and tofu
• Include more high-protein foods in your diet to support healing and recovery⁸

Mental health support:

It’s normal to feel sad, worried, or stressed after a transplant. Support from your friends, family, and your healthcare team can help you overcome this. You can talk with a mental health support counsellor or join a support group if you need extra help.

 Follow-up care includes:

• Regular blood tests, bone marrow exams, and monitoring long-term side effects
• You might need to be vaccinated again, as your immunity from previous vaccines may be lost after an allogeneic transplant
• Regularly screen for other health problems and transplant complications

Summary

Stem cell transplantation is a complex but life-saving method used for treating leukaemia. By replacing the damaged bone marrow with new healthy stem cells, your body can make normal blood cells again. Even though recovery takes time, with proper medical care, lifestyle modifications, and emotional support, you will be able to rebuild your strength, lower your risks, and move toward a better life.