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What are Stem Cell Transplantation Options for Patients Who Have Blood Cancers

BONE MARROW TRANSPLANT

The following information is a general summary and is not all-inclusive. Each patient has unique circumstances, so patients should discuss all appropriate therapies with their doctors.

Table of Contents

Acute lymphoblastic leukemia (ALL)

  • The decision to perform a transplant for an adult who has ALL depends on the features of the leukemia, the patient’s general health and the patient’s age. 
  • An allogeneic stem cell transplant may be an option for patients with high-risk ALL whose disease is in remission for the first time or whose disease is in a partial remission (provided a suitable donor is available).
  • The choice between allogeneic transplantation and continued chemotherapy is less clear for patients who have standard-risk ALL and whose disease is in first remission. These patients should discuss standard and/or reduced-intensity allogeneic stem cell transplantation with their doctors to determine if either of these types of transplants are recommended for them. A minimal amount of residual disease may influence the decision of whether or not to proceed to transplantation.
  • Autologous stem cell transplantation outside of the clinical-trial setting is not recommended as treatment for ALL.
  • Most children with ALL (about 75 to 80 percent) do not need stem cell transplantation. A child with refractory disease or relapsed ALL may be considered for allogeneic transplantation

Acute myeloid leukemia (AML)

  • Favorable-risk AML: Stem cell transplantation is generally not recommended with first complete remission. 
  • Intermediate-risk AML: Patients with intermediate-risk AML should discuss standard and/or reduced-intensity stem cell allogeneic transplantation with their doctor to determine if one of these transplantations is recommended for them.
  • High-risk AML: Allogeneic stem cell transplantation is generally recommended with first remission or in a partial remission for patients who are candidates for a transplant and have a suitable allogeneic donor. Reduced-intensity allogeneic stem cell transplantation may be recommended for older patients or patients who have certain comorbidities. 
  • Autologous stem cell transplantation outside of a clinical-trial setting is not commonly used to treat AML

Chronic lymphocytic leukemia (CLL)

  • Allogeneic transplantation (usually reduced-intensity but sometimes standard) is under study in clinical trials as treatment for patients who have CLL that has certain high-risk features or disease that has relapsed after standard therapies

Chronic myeloid leukemia (CML)

  • In cases of either advanced or refractory disease or intolerance of oral CML therapies, standard allogeneic stem cell transplantation (or reduced/intensity allogeneic stem cell transplantation) may be recommended for patients who have a suitable allogeneic donor available

Hodgkin lymphoma (HL)

  • Autologous stem cell transplantation is used to treat HL patients whose disease relapses after initial therapy. 
  • Standard and reduced-intensity allogeneic stem cell transplantation are under study in clinical trials as treatment for HL patients who have a suitable allogeneic donor.

Non-Hodgkin lymphoma (NHL

  • Autologous stem cell transplantation is generally used to treat patients who have relapsed or refractory disease; transplantation during first remission is done only in clinical trials, with the exception of some types of NHL, including certain cases of mantle cell lymphoma and T-cell lymphoma. 
  • Allogeneic transplantation is used to treat selected patients who have NHL.
  • Patients should check with their doctors and find out if there are specific recommendations for their subtype of NHL.

Myelodysplastic syndromes (MDSs)

  • A standard allogeneic stem cell transplant (or a reduced-intensity allogeneic stem cell transplant for older or other selected patients) may be recommended for people who have intermediate- or high-risk MDS and a suitable allogeneic donor available.

Myeloma

  • Autologous stem cell transplantation is an important part of treatment for certain myeloma patients. 
  • Allogeneic stem cell transplantation is not commonly used for myeloma patients but it may be a treatment option for selected younger patients who have a suitable allogeneic donor available. 
  • Reduced-intensity allogeneic stem cell transplantation is used in some cases following autologous stem cell transplantation for patients who have a suitable allogeneic donor available.

Myeloproliferative neoplasms (MPNs)

  • Myelofibrosis: A standard allogeneic stem cell transplant (or a reduced-intensity allogeneic stem cell transplant for older patients or patients who have certain comorbidities) may be recommended for patients who have a suitable allogeneic donor available.
  • Polycythemia vera (PV) and essential thrombocythemia (ET): Allogeneic stem cell transplantation and reduced-intensity allogeneic stem cell transplantation are occasionally used to treat these diseases.
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