The usual doses of chemotherapy drugs can reduce the number of leukemia cells in chronic lymphocytic leukemia and improve symptoms, but even if signs of leukemia go away, the disease often comes back later. Higher doses of these drugs might be more effective, but they often cannot be given because they could severely damage bone marrow, which is where new blood cells are formed. This could lead to life-threatening infections, bleeding, and other problems because of low blood cell counts.
A stem cell transplant (SCT) allows doctors to use higher doses of chemotherapy, sometimes along with radiation therapy, to treat the leukemia. After these treatments are finished, the patient receives a transplant of blood-forming stem cells to restore the bone marrow.
Blood-forming stem cells used for a transplant are obtained either from the blood (for a peripheral blood stem cell transplant, or PBSCT), from the bone marrow (for a bone marrow transplant, or BMT), or from umbilical cord blood. Bone marrow transplant was more common in the past, but it has largely been replaced by PBSCT.
It's not yet clear how helpful stem cell transplants are in patients with chronic lymphocytic leukemia (CLL). When these treatments are used, it is most often in clinical trials looking to test their effectiveness.
The 2 main types of stem cell transplants are allogeneic and autologous.
For an autologous transplant, the patient’s own stem cells are collected from the blood or bone marrow and then given back after treatment. The problem with that is that leukemia cells may be collected with the stem cells.
In an allogeneic transplant, the stem cells come from someone else (a donor). To lower the chance of complications, the donor needs to “match” the patient in terms of tissue type. Often, a close relative, such as a brother or sister is a good match. Less often, a matched unrelated donor may be found.
Because collecting the patient’s stem cells can also collect leukemia cells, allogeneic transplants are used more often in the treatment of CLL than autologous. Still, this type of transplant can cause severe or even life-threatening complications and side effects, and it is often not be a good option in people who are older or have other health problems.
For more information on stem cell transplants, see Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants).
Last Revised: 02/23/2016