Stem-cell (bone marrow) transplant

What it is

In an allogeneic stem-cell transplant, high-dose chemotherapy (sometimes with radiation) — the “conditioning” regimen — wipes out the leukemia and the patient’s bone marrow, and healthy blood-forming stem cells from a matched donor are then infused. The donor cells rebuild a new blood and immune system, and the donor immune cells help attack any remaining leukemia (the “graft-versus-leukemia” effect). Because it carries significant risks, it is reserved for high-risk or relapsed B-ALL.

Why it's done

• High-risk B-ALL features or a poor MRD response
• Relapsed disease after achieving a new remission
• Often after immunotherapy or CAR-T, to consolidate remission

How it’s done

Once a matched donor is identified, the patient receives conditioning chemotherapy (with or without radiation), then the donor stem cells are given as an IV infusion. A prolonged hospital stay follows while the new marrow engrafts, with immune-suppressing medicines to prevent rejection and graft-versus-host disease.

Recovery & follow-up

Weeks in hospital and months of recovery with frequent monitoring; immune recovery takes many months. Long-term follow-up watches for graft-versus-host disease, infection and late effects.

Risks & considerations

• Graft-versus-host disease (acute and chronic)
• Serious infection during immune recovery
• Organ toxicity from conditioning (including veno-occlusive disease)
• Graft failure and risk of relapse
• Late effects — fertility, endocrine, and secondary cancers

Alternatives