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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Cancer treatments

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.

Conditioning treatment

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.