Stem cell transplant for chronic lymphocytic leukaemia (CLL)

A stem cell transplant isn't a common treatment for chronic lymphocytic leukaemia (CLL). You usually have stem cells from another person (a donor) for CLL.

When do you have a transplant for CLL?

The aim of transplant is to try to cure the leukaemia. Or to control it for longer than is possible with other types of treatment. 

Your doctor is most likely to suggest a transplant if:

• you are young and well enough to have intensive treatment
• your leukaemia has come back quite quickly after your initial treatment

What are stem cells and bone marrow?

Bone marrow is a spongy material that fills the bones.

It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.

You have a stem cell  transplant after chemotherapy.  The chemotherapy has a good chance of killing the cancer cells. But it also kills the stem cells in your bone marrow.

For CLL, you usually have a stem cell transplant using stem cells from a donor. This is called an allogeneic transplant. 

Reduced intensity conditioning transplant

Some people who have a donor transplant might have a mini transplant. This is also called a reduced intensity conditioning (RIC) transplant. 

You have lower doses of chemotherapy than in a traditional stem cell transplant. You might have this treatment if you are older (usually over 50 years), or not fit or well enough for a traditional transplant. 

Having stem cells from a donor

Your donor stem cells

The stem cells of your donor need to be as similar as possible to yours.

The most suitable donor is usually a brother or sister. There is a 1 in 4 chance of a brother or sister being a good match.

It is possible to get a match from a donor who is not a relative. Your doctor will contact one of the registers in the UK to see if there is a suitable donor. This is called a matched unrelated donor (MUD).

Matching donor stem cells

Everyone has their own set of proteins on the surface of their blood cells. The staff in the laboratory compare the surface of your blood cells and the donor blood cells. Your brother or sister are most likely to have similar proteins to you. 

The staff check to see how similar the donor cells are to your own. This test is called HLA typing or tissue typing.

The laboratory staff look for proteins called HLA markers and histocompatibility antigens. They check for 10 HLA markers. The result of this test shows how good the HLA match is between you and the donor.

What happens

Before your chemotherapy, your team collects your donor's stem cells or bone marrow.  

You have chemotherapy. After the treatment you have the stem cells into a vein through a drip. The cells find their way back to your bone marrow. Then you can make the blood cells you need again. It can take a few days or weeks for the stem cells to start making enough blood cells.

Possible side effects

The main side effects of high dose chemotherapy and transplant include:

• increased risk of getting an infection
• low blood cell counts
• increased risk of bleeding
• a reaction called graft versus host disease - this is when the donor cells attack some of your own body cells