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For some patients with ALL, chemotherapy alone may bring long-term remission. Remission means that tests cannot find any leukemia cells and a patient is symptom-free. But for others, the disease is more aggressive and chemotherapy alone may not be enough. For these patients, getting a referral to a transplant doctor early in their disease may offer the best route to a cure or a long-term remission.

A bone marrow or cord blood transplant begins with chemotherapy, with or without radiation, to destroy the diseased cells and marrow. The transplant replaces diseased blood-forming cells with healthy ones.

Be The Match is here to assist you and your family as you plan for transplant. Our patient services coordinators can answer your questions and provide support and education to help you navigate your transplant journey.

There are two types of bone marrow transplants: allogeneic and autologous. An allogeneic transplant uses healthy blood-forming cells from a family member, unrelated donor, or umbilical cord blood unit. An autologous transplant uses the patient’s own blood-forming cells which are collected and stored.

Most transplants for ALL are allogeneic. Autologous transplant isn’t usually used for ALL because the risk of relapse (a return of the disease) is higher than with allogeneic transplant.

Understanding if transplant would help your ALL

Whether a transplant is right for you depends on how likely the leukemia is to return. This is based on certain features of the leukemia, called risk factors, and your general health. A transplant doctor will weigh the risk of the leukemia coming back against getting a transplant. A transplant may cure the leukemia, but may also cause other problems. The doctor also considers whether your specific risk factors are a sign that chemotherapy is not likely to lead to a cure or long-term remission.

One way a doctor determines how likely the leukemia is to return is through cytogenetic testing. This means looking at the chromosomes in the leukemia cells. Chromosomes are thread-like strands of DNA that carry genetic information about your body. Certain changes in the chromosomes predict a lower risk of the disease returning. Others predict a higher risk.

If your disease has a high chance of returning and you are a good candidate for a transplant, delaying a transplant may lower your likelihood of long-term remission or cure.

There are medical guidelines for when someone should be referred for a transplant consultation, whether or not you might need a transplant at that time. Talking to a transplant doctor is especially recommended if your disease has any of the following features1:

For ALL in adults:

  • Your initial chemotherapy doesn’t lead to remission within 28 days of starting treatment
  • Molecular or cytogenetic testing of the ALL shows high-risk disease
  • You relapse one or more times after chemotherapy

For ALL in children:

  • Your child is an infant at diagnosis
  • Your child has high-risk features such as a high white blood cell count at diagnosis
  • Molecular or cytogenetic testing of the ALL shows high-risk disease
  • Child’s initial chemotherapy doesn’t lead to remission within 28 days of starting treatment
  • Child relapses one or more times after chemotherapy

Learn more about bone marrow transplants and access resources to help you navigate your transplant journey. 

1. Recommended Timing for Transplant Consultation. Guidelines developed jointly by National Marrow Donor Program/Be The Match and the American Society for Blood and Marrow Transplantation (ASBMT). Available at: marrow.org/md-guidelines