Stem Cell Transplant for CLL
- When standard treatments have failed, stem cell transplant may be an option for patients with aggressive CLL.
- Stem cell transplants replace the patient’s immune system with healthy cells from either the patient themselves (autologous) or a donor with matching tissue (allogeneic).
- The procedure clears CLL cells and prevents their return.
- In some cases, stem cell transplant is effectively a cure, but the procedure does carry risks and side effects so it is not the right choice for every patient.
In those cases, doctors may consider stem cell transplantation.
Read MoreRelated: What Happens After A Stem Cell Transplant?
What is a stem cell transplant?
A stem cell transplant involves taking healthy immune system cells from a donor whose cell types closely match the patient’s.
The new immune cells from the donor work by targeting and destroying any remaining CLL cells in the patient’s body. The new cells are able to recognize and fight off the CLL better than the patient’s original immune cells could.
“For our patients where we don’t think we can count on the treatments we have to hold them in remission for really the rest of their lives, then transplant something to consider,” Dr. Choi says.
What are the types of stem cell transplants?
There are two types of stem cell transplants used in CLL.
Autologous Stem Cell Transplant:
This involves using the patient’s own stem cells.
The process starts with collecting stem cells from the patient’s blood and storing them. The patient then undergoes high-dose chemotherapy, sometimes with radiation, to kill as many cancer cells as possible.
One of the downsides to this process is that it also destroys healthy blood-forming cells in the bone marrow. However, once the stored stem cells are then returned to the patient’s body, they help rebuild the bone marrow.
Autologous transplants are less commonly used in CLL because they are usually not a cure. The cancer often returns because the patient’s own stem cells might still contain cancer cells.
Allogeneic Stem Cell Transplant:
This involves stem cells from a donor. The donor can be a family member like a parent or sibling, or an unrelated donor who matches the patient’s tissue type.
Before the transplant, the patient receives chemotherapy, with or without radiation, to destroy the cancerous cells and suppress the immune system, making room for the donor’s stem cells.
The donor’s healthy stem cells are then transferred to the patient.
Allogeneic transplants can potentially cure CLL because the donor’s immune cells effectively attack and kill the CLL cells— a phenomenon known as the graft-versus-leukemia effect.
However, this procedure carries some risks. This includes the potential for something known as graft-versus-host disease (GVHD), where the donor’s immune cells attack the patient’s normal tissues.
Allogeneic transplants are more commonly used in CLL, especially for patients with aggressive disease or those who have not responded to other treatments.
The choice between these transplant types depends on various factors, including:
- Patient’s overall health
- Characteristics of their CLL
- Availability of a suitable donor
Stem cell transplantation can be a powerful option for certain CLL patients but Dr, Choi says that because of the risks involved, it’s a treatment that is only considered after careful evaluation and when other treatments have not worked.
Related: Clinical Trials for CLL Treatments
Who is a good candidate for stem cell transplant?
“We don’t want to have every one of our patients get a stem cell transplant,” Dr. Choi says, “Otherwise for some of those we may be trading manageable or something that we can manage with other drugs for a graft versus host disease that may require more intensive or potentially more risky treatments to manage.”
Good candidates for stem cell transplant in CLL are patients with high-risk or aggressive disease that hasn’t responded well to other treatments.
Specifically, allogeneic stem cell transplantation (using donor cells) is considered for CLL patients who:
- Need stronger treatments because their disease quickly returned or didn’t respond to initial therapies
- Have genetic abnormalities like TP53 mutation or deletion 17p, which are associated with a more aggressive disease progression
- Have not responded or have rapidly relapsed (within 6-12 months) after other treatments
- Have experienced Richter transformation, which is a more aggressive disease state. However, patients like this often respond well enough to the transplant to allow time for the graft-versus-leukemia effect to occur.
What happens after a stem cell transplant?
After the transplant, doctors closely watch the patient for any signs that the CLL might be coming back.
The goal is to ensure that the new immune system keeps the CLL in check, maintaining the patient’s health over time.
“The hope and what has been seen in the past with stem cell transplant is that some patients are effectively cured, that the new immune system will clear the CLL cells and then kind of maintain surveillance to keep the CLL cells from coming back.” Dr. Choi says.
The risk of CLL returning varies based on several factors:
- The patient’s specific disease characteristics
- Response to the transplant.
- High-risk features like TP53 mutations or early relapse after previous treatments
However, with advancements in treatment, including targeted therapies, outcomes for patients have been improving.
Life after a stem cell transplant involves a period of recovery and adjustment.
Here’s what to expect:
- Frequent medical check-ups
- Medication to prevent complications
- Careful monitoring for signs of graft-versus-host disease (GVHD).
- Dietary changes
- Avoiding large crowds or sick people to prevent infections
Dr. Nicole Lamanna explains what Richter’s Transformation is and how it is treated
Questions for your doctor
- Am I a good candidate for stem cell transplantation? If so, which type is right for me?
- What are the potential benefits and risks of undergoing a stem cell transplant?
- What results can I expect and how long will it take to see them?
- What part of the treatment is covered by insurance and what can I expect in terms of out of pocket costs?
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