When stem cell transplant (SCT) might be used
Acute lymphocytic leukemia (ALL): In ALL, SCT might be used for a child whose
leukemia doesn’t respond well to initial treatment or relapses (comes back) early after
going into remission. It’s less clear if SCT should be used for children whose ALL
relapses more than 6 months after finishing the initial chemotherapy. These children will
often do well with another round of standard dose chemotherapy.
SCT may also be recommended for children with some less common forms of ALL, such
as those whose leukemias have the Philadelphia chromosome or those with T-cell ALL
that doesn’t respond well to initial treatment.
Acute myelogenous leukemia (AML): Because AML relapses more often than ALL,
many doctors recommend SCT for children with AML right after they have gone into
remission, if the child has a brother or sister with the same tissue type who can donate
stem cells for the transplant. This is especially true if there is a very high risk of relapse
(as with some subtypes of AML or when there are certain chromosome changes in the
cells). There is still some debate about which children with AML need this type of
intensive treatment.
If a child with AML relapses after his or her first round of standard chemotherapy, most
doctors will recommend SCT as soon as the child goes into remission again.
In either case, it is important that the leukemia is in remission before getting a stem cell
transplant. Otherwise, the leukemia is more likely to return.
Other leukemias: SCT might also offer the best chance to cure some less common types
of childhood leukemia, such as juvenile myelomonocytic leukemia (JMML) and chronic
myelogenous leukemia (CML). For CML, newer targeted therapies are likely to be used
first for most children, but a transplant might still be needed at some point.
Practical points
A stem cell transplant is a complex treatment that can cause life-threatening side effects.
If the doctors think your child can benefit from a transplant, the best place to have this
done is at a nationally recognized cancer center where the staff has experience with the
procedure and with managing the recovery period.
A stem cell transplant often requires a long hospital stay and can be very expensive (often
costing well over $100,000). Be sure to get a written approval from your insurer before
treatment if it is recommended for your child. Even if the transplant is covered by your
insurance, your co-pays or other costs could easily amount to many thousands of dollars.
It’s important to find out what your insurer will cover before the transplant to get an idea
of what you might have to pay.