Stem-Cell Transplants to Treat Acute Myeloid Leukemia: What You Need to Know Before, During, and After

A stem-cell transplant doesn't directly fight cancer cells, rather it helps your body create healthy cells after chemotherapy and other treatments have destroyed them.

The first course of treatment for AML patients is generally a combination of two chemotherapy drugs, known as "induction chemotherapy." Its goal is to kill cancer cells, but along with killing cancer cells, chemotherapy also kills the body's healthy cells and platelets. A stem-cell transplant is designed to help rebuild those blood cells and platelets and restore the immune system. The healthy new cells may also help prohibit recurrence of the disease.

Related: What Are The Risk Factors Associated With Acute Myeloid Leukemia?

"We don't believe that chemotherapy, for the majority of leukemias, is sufficient in order to cure patients of their disease, forever," Dr. Caitlin Costello, hematologist-oncologist at UC San Diego Health, tells SurvivorNet. "And so a transplant is an opportunity to do that cure patients with leukemia."

Dr. Caitlin Costello breaks down the basics about stem-cell transplants for SurvivorNet. 

What Is a Stem-Cell Transplant?

During a stem-cell transplant, healthy cellseither from your own body (known as an autologous stem-cell transplant) or from a donor (known as an allogeneic stem-cell transplant)are injected into the blood in order to help your body produce the healthy cells and platelets it needs. In some cases, the cells come from the blood. In others, they come from the bone marrow, in which case the procedure is referred to as a bone-marrow transplant, which is a type of stem-cell transplant.

If it's determined that a stem-cell transplant is right for you, the following steps are taken:

Collection: Stem cells are taken either from your bone marrow or blood or from a donor.

Conditioning: The process may vary among patients, but it typically involves chemotherapy and/or radiation to remove as many of the cancer cells as possible.

Infusion: Stem cells are infused into the bloodstream via an IV or catheter.

Related: People With Blood Cancer Are More Vulnerable to COVID-19: What You Need to Know

A stem-cell transplant feels much like any transfusion. Patients are awake during the procedure, which is painless. The time a transplant takes depends on the amount of fluid being infused, which varies by patient.

AML bone marrow transplant basics explained.

Which AML Patients are Candidates for Stem-Cell Transplants?

Not all AML patients are candidates for a stem-cell transplant. Some need only chemotherapy, and some high-risk patients may not be able to tolerate a transplant. It all comes down to your medical team determining your risk group.

Dr. Raoul Tibes, director of the Clinical Leukemia Program at NYU Langone Health,  told SurvivorNet in an earlier interview that AMLs are grouped according to what are called cytogenetics (loss or changes to the structure of chromosomes) and other molecular markers. Doctors also look for genetic mutations on top of chromosomes, which could be indicators of risk.

"Based on all that information, we can group leukemias into the chromosome status, as well as mutations and genes. We take them together and then we have three or four different risk stratification groups," he says. "That helps us decide which therapy we use."

Dr. Raoul Tibes discusses how an individual’s AML risk group is determined with SurvivorNet.

Stem-cell transplant side effects

As effective as stem-cell transplants can be, they also often come with side effects. You might feel extreme fatigue, loss of appetite, experience stomach issues, find mouth sores, and more. As the immune system rebuilds itself, symptoms typically subside.

"The light at the end of the tunnel starts to emerge when we see your new immune system starting to grow," Dr. Costello tells SurvivorNet. "So, every day we check your blood levels and we see that your old immune system, which has died, is now slowly starting to grow your new immune system."

Those who receive a stem-cell transplant may experience some of these side effects.

What to Expect After a Stem-Cell Transplant

After a stem-cell transplant, patients are typically kept in the hospital for several weeks. The immune system is significantly compromised after the procedure, and it takes time for the new bone marrow to grow and start doing its job. Because the risk of infection and other complications is high, patients are closely monitored and given protective antibiotics, anti-virus medicines and anti-fungal medicines to keep them safe in the meantime.

Related: What Are The Options For Patients When Acute Myeloid Leukemia (AML) Returns?

Once in remission, there's still a threat of relapse. Doctors typically will monitor your blood count so that treatment can start immediately if the disease remerges.

Here’s what you can expect after a stem-cell transplant for AML.

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