What Happens During a Stem Cell Transplant for CLL

Stem cell transplants are not a common treatment for chronic lymphocytic leukemia (CLL). When they are used, here’s what happens.

Stem cell transplants may be autologous, which means the stem cells come from your own body. Or they may be allogeneic, which means the stem cells come from a donor. Doctors usually prefer to do an allogeneic transplant if a suitable stem cell donor can be found. Doctors may do an autologous transplant because it is hard to find an exact match from a donor. However, there is also concern that the stem cells from your own body could be contaminated with leukemia cells, even after treatment in a lab. Discuss the risks and benefits with your doctor beforehand. Doctors commonly advise waiting for an induced remission and for the chemotherapy side effects to wear off before proceeding with the transplant, if possible. Here’s a general description of how a stem cell transplant is done.

Retrieving the needed stem cells

• First, your doctor will remove stem cells from you or from a matched stem cell donor. Doctors usually retrieve them during a process called apheresis. It involves receiving a growth factor drug by injection for several days. This drug helps stimulate stem cell production and migration from the bone marrow into the bloodstream. Then a small tube, called a catheter, is used to obtain blood from your vein or that of the donor. This is similar to donating blood, but takes several hours. The blood goes to a cell separation device to remove the stem cells. Then the extra blood is returned to you or the donor. You may need to have this process repeated more than once. The stem cells are then frozen until needed later. 

• An alternative procedure requires retrieving stem cells from the bone marrow of either you or your donor. You or the donor receives general anesthesia. A doctor makes several punctures in the pelvic bone to remove marrow. Soreness may last for several days. These stem cells are filtered and frozen until needed later. 

Receiving the transplant

• You will be admitted to the hospital the day before your transplant. Your doctor will go over how to keep your gown sterile and how to prepare your food after the transplant. This is needed to lower your exposure to infections.

• After the chemotherapy or radiation therapy is finished, you will receive the stored stem cells through a needle in your arm that’s attached to a tube. This is similar to a blood transfusion.

• You will then have to wait for your stem cells to start multiplying. You may have to remain in isolation to avoid getting an infection. Once the part of your white blood cell count, called the absolute neutrophil count, reaches 500, you can come out of isolation. Once it reaches 1,000, you may be able to return home. This may happen within three to six weeks or longer.

• You will need to have a standard tube of blood withdrawn daily to monitor your blood cell count for the next several weeks. This is done on an outpatient basis.