What is chronic lymphocytic leukemia (CLL)?
CLL is a blood cancer that starts in the bone marrow. Bone marrow is the soft, spongy tissue inside bones. In CLL, the bone marrow makes too many abnormal white blood cells. They don’t work properly and prevent the marrow from making normal red blood cells, white blood cells and platelets. With fewer healthy blood cells, the body can’t fight infections or stop bleeding.
How does blood or marrow transplant (BMT) work for CLL?
BMT, also known as a bone marrow transplant or blood stem cell transplant, replaces the unhealthy bone marrow with a healthy one. For some people, BMT can cure their disease.
The most common type of transplant for CLL is an allogeneic transplant. This type of transplant uses healthy blood-forming cells donated by someone else to replace the unhealthy ones. These healthy cells can come from a family member, unrelated donor or umbilical cord blood. First, you get chemotherapy (chemo), with or without radiation, to kill the unhealthy cells. Then, the healthy donated cells are given to you through an intravenous (IV) catheter. The new cells travel to the inside of your bones and begin to make healthy blood cells.
The entire process, from when you start chemo or radiation, until hospital discharge, can last weeks to months. This is followed by many months of recovery near the transplant center and at home. Your transplant team will closely watch you to prevent and treat any side effects or complications.
When should I see a transplant doctor?
You should see a transplant doctor if the CLL:
- Has a high risk of coming back (relapse)
- Comes back quickly after chemo
- Doesn’t get better after chemo
Your first appointment with a transplant doctor
At your first appointment, the transplant doctor will:
- Review your medical history
- Talk with you about your treatment options
- Discuss the risks and benefits of transplant
- Recommend the best time for you to get a transplant and prepare for treatment
- Start a donor search even if you don’t need it right away. This can help you get a transplant faster if it’s needed later
Learn about your risk for relapse
Doctors do cytogenetic and molecular testing to see how likely it is that the CLL will come back (relapse). This means they look at the chromosomes and genes in the leukemia cells. Chromosomes and genes carry instructions that tell the body how to make everything it needs to work properly. Certain changes in the CLL chromosomes and genes predict a lower risk of relapse. Others predict a higher risk. To do this testing, doctors study your blood and bone marrow.
Ask your doctor for a copy of your test results and to explain what they mean. Remember, if your disease has a high risk of relapse and you’re healthy enough for transplant, it’s important to schedule see a transplant doctor right away.
Questions to ask your doctor
Ask questions so you understand your treatment options and can make decisions that are best for you. Questions you may want to ask include:
- What are my chances of a cure or long-term remission if I get a transplant? If I don’t get a transplant?
- Does the type of CLL I have make a difference on how well transplant might work for me?
- Does my current health or age affect how well transplant might work for me?
- What do my cytogenetic and molecular markers mean for my treatment?
- What are the possible side effects of transplant? How can they be reduced?
- How might my quality of life change over time, with or without transplant?
Most recent medical review completed March 2017.