NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
Stem cell transplant
You may have an allergic reaction while receiving
rituximab. Other common side effects are chills,
infections, body aches, tiredness, and low blood cell
counts. Rituximab rarely increases the chance of
developing TLS, heart problems, and blockage and
holes in your intestines.
Stem cell transplant
An SCT is a treatment that destroys cells in the
bone marrow then replaces them with new, healthy
blood-forming cells. These blood-forming cells are
called blood stem cells or hematopoietic stem cells.
This treatment is also called a hematopoietic cell
The goal of an SCT is to cure cancer by replacing
unhealthy blood stem cells with healthy ones that will
attack cancer cells. This is done by suppressing the
bone marrow and cancer with chemotherapy then
transplanting healthy blood stem cells. The healthy
blood stem cells will grow, form new bone marrow
and blood cells, and attack remaining cancer cells.
For the treatment of ALL, blood stem cells from a
donor are used for the transplant. This is called an
allogeneic SCT. Before the transplant, special testing
must be done to make sure the donor is a good
match for you. HLA typing is used to find a person’s
tissue type, called an HLA type. (See page 17 for
more details on HLA typing.)
An allogeneic SCT creates a new immune system
for your body. Another benefit of this transplant is the
eukemia) effect. The GVL effect
is an attack on the leukemia cells by the transplanted
blood stem cells. The steps of treatment with an
allogeneic SCT are described next.
Before the transplant, you will receive high-dose
chemotherapy and maybe high-dose radiation
therapy. This is called conditioning treatment since
it prepares (conditions) your body to receive the
donated blood stem cells.
The chemotherapy is given to destroy any remaining
leukemia cells in your bone marrow. But, it also
destroys normal blood cells in your bone marrow.
This greatly weakens your immune system so that
your body doesn’t kill the transplanted blood stem
For some patients, lower doses of chemotherapy or
radiation may be used before the transplant. This
is called non-myeloablative or reduced-intensity
conditioning. This type of conditioning may be a good
option for certain patients who are older or in poorer
health. It can often work just as well as high-dose
Transplanting the stem cells
After the chemotherapy, the blood stem cells will be
put into your body with a transfusion. A transfusion is
a slow injection of blood products into a large vein.
This process can take several hours to complete.
The transplanted stem cells then travel to your bone
marrow and grow. They will make new, healthy blood
cells. This is called engraftment. It usually takes
about 2 to 4 weeks.
Until then you will have little or no immune defense.
This puts you at high risk for infection and bleeding.
You will likely need to stay in a hospital in a very
clean room for some time. It may take a few weeks
or months for blood cells to fully recover so that your
immune system is back to normal.