Allogenic Bone Marrow Transplantation (BMT) is one of the most important treatments against different kinds of leukemias. In this process, malignant or non-functional bone marrow is replaced with functional bone marrow obtained from a donor. This is resorted to in cases where other treatments have failed or when the incidence of leukemia's recurrence is potentially high. Herein, we outline the use of allogeneic BMT for the treatment of leukemias, including the type of leukemias to be treated, the transplantation procedure, and results, along with challenges, of this therapy.
Contents
- Overview
- Types of Leukemia Treated with Allogeneic BMT
- The Allogeneic BMT Process
- Possible Advantages and Disadvantages
- Care and Follow-up after Transplant
- Prognosis and Results
- Living With a Bone Marrow Transplant
- Additional Common Questions
Overview
Allogeneic BMT represents a complicated procedure for the treatment of cancers of the blood, more precisely leukemias. Leukemia is the cancer of blood and bone marrow, indicated by rapid growth without control of abnormal blood cells. Fast and uncontrolled production brings about an imbalance in normal blood cell formation and function, hence certain problems to health.
Allogeneic BMT refers to the procedure in which the patient's diseased bone marrow is replaced with the healthy material of an appropriate donor. In other words, through the transplant of healthy marrow, normal blood cells are manufactured which can achieve complete remission or cure of the leukemia.
Types of Leukemia Allogeneic BMT Can Treat
Allogenic BMT's are useful in treating the following types of leukemia:
Acute Lymphocytic Leukemia: This is the most common leukemia in children, although adults are also often affected. ALL is a rapidly progressive disease; in most cases, treatment is initiated immediately. Allogeneic BMT may be recommended for patients who have had a relapse or are at high risk of experiencing one.
AML is an acute myeloid leukemia that is more common in adults, with peak incidence in those over 65 years, although it can occur in children. It is a neoplasm where abnormal myeloid cells reproduce quickly. In patients with either high-risk or relapsed AML, allogeneic BMT is an option.
CLL: the most common in patients > 65 years. Most of CLL is quite indolent, and generally, the use of allogeneic BMT is reserved for those patients presenting with aggressive disease or having progressive disease not amenable to other treatments.
Chronic Myelogenous Leukemia: This leukemia very rarely occurs in infants and children and is mainly confined to the elderly because of its specific nature. It is a slowly growing process, and allogenic BMT is usually kept aside for patients who do not respond to the small molecule targeted therapy or where the disease has progressed despite the best efforts.
An Overview of How Allogeneic BMT Works
Broadly speaking, there are three main steps in the process of allogenic BMT:
Donor Matching:
A compatible donor is needed. The donor will need a good human leukocyte antigen (HLA) match to reduce the complication of graft-versus-host disease. The donors would include the family or unrelated persons identified through these registries.
Pre-Transplant Work-ups:
Conditioning Regimen: Prior to transplantation, patients are put on a conditioning regimen that involves high-dose chemotherapy and/or radiation. This is to attempt to kill off the leukemia cells and suppress the immune system of the patient as a whole to prevent rejection of the new bone marrow.
Stem Cell Infusion:
Healthy stem cells from the donor are given to the patient via infusion into the bloodstream. These stem cells go into the patient's bone marrow and start producing new, healthy blood cells.
Engraftment:
Post-infusion, new bone marrow begins to produce blood cells. Engraftment is the process by which donor stem cells take over, grow, and function in the patient's body. This process is followed by blood tests and other checks.
Follow-up Care:
Monitoring and close care of the patient for the management of side effects, infections, and complications like GVHD are important features of this phase. Immunosuppressive medications to suppress the immune system and other supportive medications during this phase are very important.
Possible Advantages and Risks
Advantages of Allogeneic BMT:
Curative Potential: Allogeneic BMT is able to offer a potential cure or long-term remission of leukemia to some patients.
Restoring Healthy Blood Cells: This procedure may aid in restoring the normal count of blood cells, following which overall health and life quality may be enhanced.
Dangers and Complications:
- Graft-Versus-Host-Disease: A condition that occurs when the immune system cells of the donor attack the patient's tissues. GVHD may be acute or chronic and needs to be closely monitored and treated.
- Infections: The immune system is greatly weakened following a transplant, and this increases the chances of infection.
- Organ damage: High-dose chemotherapy and radiation can induce organ damage in the liver, lungs, and heart.
- Relapse: Even after successful transplantation, leukemia can recur.
Care and Follow-up after Transplantation
Patients are usually followed up repeatedly after having had an allogeneic BMT to observe the process of recovery and detect problems developed after the procedure. The routine follow-up program includes:
Blood Tests: This facilitates the detection of the blood count and the development of infection or relapse.
Medication Management: Comprises immunosuppressive drugs to prevent GVHD and other medicines used in the management of side effects.
Supportive Care: Various supportive measures are taken at each step to bring about a complete recovery and to provide the patient with a normal life after transplantation; these comprise nutritional support, physical therapy and psychological care.
Prognosis and Outcome
The prognosis following an allogeneic BMT is predicated on numerous factors:Leukemia Type: Various types of leukemia show various response rates for transplantation.
Patient's Age and General Health Condition: Outcome is better in young patients and those in good general health. Donor Compatibility: A good HLA match between donor and recipient increases the chances of a successful transplant. Effectiveness of Pre-transplant Treatment: The effectiveness of conditioning regime and response to pre-transplant treatment impact the outcome.
Survival Rates: Stem cell transplantation, especially allogenic BMT, has a possibility for patients to experience improved survival. However, survival rates in the case of allogenic BMT may vary from one patient to the other. It all depends on the type of leukaemia in any patient, how serious the patient's condition is, and how exactly the transplant act has been managed. For example, a patient having ALL or AML may pose the survival rates from a patient with CLL or CML.
Living With a Bone Marrow Transplant
Life after allogenic BMT requires continuous monitoring and care. He may have some long-term effects which include-
- Chronic GVHD: Requires, in most cases, continuous treatment and management.
- Adjustments Physically and Emotionally: A feeling of adjustment to changes in health and alterations in lifestyle
- Regular Follow-up: necessary for early detection of any complication and continuous monitoring of health
Other Frequently Asked Questions
How Can I Find Clinical Trials for Leukemias? Clinical trials may offer access to new treatment and therapies. Find clinical trials at the following locations:
- Leukemia & Lymphoma Society Clinical Trial Support Center
- National Cancer Institute: Clinical Trials Information for Patients and Caregivers
- American Cancer Society: Clinical Trials
- Cancer Trials at Cleveland Clinic
How Can I Find Support Groups? Support groups are an excellent source of information and support from those going through the same or similar challenges. Seek support from
Local Leukemia & Lymphoma Society chapters A Note from Cleveland Clinic Being treated for a bone marrow transplant can be overwhelming, especially if you have leukemia. Please remember that every patient is unique. Your health care team is your best and most accurate source of information about your specific situation, treatment options, and prognosis. Openly and freely communicating with your health care provider is essential to better care and successful outcomes.
