Stem cell transplant for childhood leukemia

A stem cell transplant is sometimes used to treat childhood leukemia. It is used to replace stem cells when stem cells or bone marrow are damaged. A stem cell transplant is very risky and complex, and the procedure must be done in a specialized transplant centre or hospital.

Stem cells are found in the bone marrow, the bloodstream and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells.

A stem cell transplant uses high-dose chemotherapy, with or without total body radiation therapy, to kill all of the cells in the bone marrow. This includes both healthy cells and the leukemia cells. After high-dose chemotherapy, healthy stem cells are given to replace the ones in the bone marrow that were destroyed.

Stem cell transplants are commonly used to treat acute myelogenous leukemia (AML) because AML relapses more often than acute lymphoblastic leukemia (ALL). But some subtypes of AML respond better to treatment than others and often don’t require a stem cell transplant.

Stem cell transplants may also be used to treat some types of childhood ALL, such as:

• ALL that doesn’t respond to treatment or comes back early after remission
• subtypes of ALL that don’t respond well to treatment, such as Philadelphia chromosome–positive ALL or ALL with unfavourable chromosomal abnormalities

An allogeneic stem cell transplant is the type of stem cell transplant used with childhood leukemia. In this type of transplant, the stem cells are taken from one person (the donor) and are given to another person (the recipient). The donor may be a relative or may be unrelated to the recipient. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.

Side effects can happen with any type of treatment for childhood leukemia, but every child’s experience is different.

Side effects can happen any time during, immediately after or a few days or weeks after a stem cell transplant. Sometimes late side effects develop months or years after a stem cell transplant. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of a stem cell transplant will depend mainly on the type of chemotherapy drug or drug combination given, if radiation therapy was given and your child’s overall health. Common side effects of a stem cell transplant include:

• infection
• low blood cell counts
• nausea and vomiting
• loss of appetite
• sore mouth
• diarrhea
• hair loss
• graft-versus-host disease (GVHD)
• digestive system problems
• veno-occlusive disease (blocking of the blood vessels in the liver)

Side effects can develop months or years after treatment for childhood leukemia. Find out more about late effects for childhood leukemia.

Tell the healthcare team if your child has side effects you think might be from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Find out more about stem cell transplants and side effects of stem cell transplants. To make the decisions that are right for your child, ask the healthcare team questions about stem cell transplants.