Hematopoietic Stem Cell Transplantation For Acute Leukaemia

28 March 2023

Some time ago, Chronic Myelogenous Leukaemia (CML) had the highest mortality rate compared to the other three types of leukaemia, namely Acute Lymphocytic Leukaemia (ALL), Acute Myelogenous Leukaemia (AML) and Chronic Lymphocytic Leukaemia (CLL).

It was only with the introduction of imatinib, the first generation tyrosine kinase inhibitor, that the mortality rate of CML was finally reversed and it is now a cancer that can be managed as a chronic disease. This oral drug, which is a targeted therapy, is a major medical breakthrough and has benefited many patients.

Does this mean that leukaemia is no longer a threat to human health? Although CML can be managed with medication, ALL and AML must still be managed step by step. If left untreated, the patient's bone marrow will continue to erode and affect blood production, which can be life-threatening in as little as 3 months, so a greater awareness of leukaemia is necessary.

Bone Marrow Transplant

When it comes to the treatment of leukaemia, haematopoietic stem cell transplantation (HSCT) is an important component. It is suitable for all four types of leukaemia, but in terms of benefits, AML and ALL are more appropriate, as CML can already be treated with medication, unless it becomes acute from chronic, or the patient has failed to take medication; CLL patients are mainly elderly and face a lack of donor sources for HSCT.

“It is important to note that CLL can only be controlled, not cured, and has a risk of relapse, so if the patient is young, a HSCT is necessary. A transplant was previously performed on a young patient (30 years old) with CLL and the outcome was excellent,” shared Consultant Haematologist, Dr Ho Kim Wah.

In both acute leukaemia, two to three chemotherapeutic drugs are commonly used, in addition to injections and oral therapy, followed by targeted therapy, and finally HSCT (commonly known as bone marrow transplantation). This means that a patient's bone marrow is replaced and healthy blood stem cells from the donor are inserted to create blood cells.

Personalised Treatment

It is important to stress that not every patient with leukaemia needs a stem cell transplant and haematologists must assess the risk of different factors before making a treatment plan.

These factors include how high the patient's white blood cell count is (the higher the better), age, organ function, what type of leukaemia the patient has, prognosis, and the likelihood of recurrence.

“For example, when I see a patient with acute leukaemia, I already have a plan in mind for his next treatment. If the patient has aplastic anaemia, where the bone marrow does not grow enough or new cells to replenish the blood cells, then HSCT is a more effective option than drugs,” Dr Ho said.

Due to advances in medical technology, comprehensive support teams and increasing experience in handling HSCT cases, the mortality rate of HSCT, which used to be between 30% and 40%, has now dropped to 10% to 15%.

Rejection is the most common side effect, with the rest being infection or organ damage. Statistically, the chance of rejection is between 30% and 50%, although there are medical techniques, including drugs that can improve the situation.

In clinical practice, there are two scenarios: the first is when a patient can have a transplant but refuses and becomes critically ill, and the second is when a transplant is followed by side effects.

Make Lifestyle Changes

“Acute leukaemia patients have a weakened immune system due to chemotherapy, so my advice is to eat a clean, hygienic and well-cooked diet. Before leukaemia treatment, the doctor will involve the multidisciplinary team to perform psychological and diet counselling, and physiotherapy, so there is no need to be overly anxious.

“Intense outdoor exercise is not recommended for ALL and AML patients, but light exercise is still feasible. You should wear a mask when going out and avoid being in crowds or close quarters. You should also stop smoking and drinking, and abstain from bad habits such as staying up late,” Dr Ho said.

In reality, if a patient with CML starts taking medication, their lifestyle is no different from that of a normal person, and they only need to take their medication every day.

For CLL, it depends on the type of treatment the patient is receiving. If the patient does not require treatment, then all that is needed is to maintain a healthy lifestyle, although patients are advised to consult with their primary care doctor on what lifestyle changes are required.

Annual Blood Tests

“As a haematologist, my advice to the public is to pay attention to yourself for any warning signs such as swelling of the lymph or parts of the spleen and liver, or feeling tired easily, having frequent fevers, and bleeding gums or red spots. If you have these symptoms, go for a blood test.

“Although there is no specific screening test to detect leukaemia, specific numbers in a blood test report can give some indication. Undergoing annual blood tests for men and women after the age of 35 will not only detect the presence of leukaemia early, but will also tell if you have any health problems such as iron deficiency anaemia, which gives you a peace of mind for your health,” Dr Ho advised.

Source: Sin Chew

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