Autologous stem cell transplant

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In an autologous stem cell transplant, the stem cells come from the childs own blood or bone marrow. Some transplant centers use various methods to try to kill (purge) any leukemic cells that may be in the autologous product. There are ongoing studies to evaluate the risks and benefits of purged versus unpurged autologous transplants and determine whether autologous transplantation is better than conventional chemotherapy.

After the marrow is harvested and treated, it is cryopreserved (frozen). The child then undergoes radiation and chemotherapy or high-dose chemotherapy alone to destroy any remaining leukemia. The frozen marrow is then thawed, and reinfused into the child intravenously.

Because the childs own stem cells are used, the child does not develop GVHD. GVHD suppresses the immune system, decreasing resistance to infection. Therefore, severe or fatal infections are less common after autologous transplants than after allogeneic transplants. However, children who undergo autologous transplants have higher relapse rates because of residual leukemic cells in the marrow or, perhaps, because there is no graft-versus-leukemia effect from GVHD. Children who develop GVHD after an allogeneic transplant and survive have lower relapse rates than children who have an autologous or syngeneic transplant.

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