Hematopoietic stem cell transplantation can be classified according to the source site of stem cells: peripheral blood HSCT, bone marrow transplantation, and umbilical cord blood HSCT. Because of the ease of operation and the low damage to the donor, peripheral blood HSCT has largely replaced bone marrow transplantation in clinical practice.
HSCT can be divided into allogeneic HSCT and autologous HSCT, depending on the individual source of the cells. The term “bone marrow transplantation” or “stem cell transplantation” is often used in everyday life to describe “hematopoietic stem cell transplantation” in general.
There are many different types of leukemia, such as “acute leukemia” and “chronic leukemia”. The two types of leukemia are completely different from each other, and therefore, the treatment is completely different.
Acute leukemia
Acute leukemia can be further divided into acute myeloid leukemia and acute lymphoblastic leukemia. Most patients with acute leukemia require autologous or allogeneic hematopoietic stem cell transplantation, with the exception of acute promyelocytic leukemia and a few patients with “low-risk” acute myeloid leukemia who have a good prognosis.
Acute promyelocytic leukemia, also known as “M3,” is a special type of leukemia. It is now being treated worldwide with all-trans retinoic acid and arsenic (commonly known as arsenic), which were discovered by Chinese scholars, and with these drugs and common chemotherapy, most patients with M3 can be cured without the need for transplantation. A small number of refractory, relapsed M3 patients require hematopoietic stem cell transplantation.
“Low-risk” is a prognostic risk score based on a combination of clinical tests, and these patients do well with conventional chemotherapy and do not require transplantation. However, if a “low-risk” patient has a relapse of leukemia after remission, he or she will need a transplant.
Chronic leukemia
Chronic leukemia can be further divided into chronic granulocytic leukemia and chronic lymphocytic leukemia, as well as a few other types of chronic leukemia.
The main character in “I am not a druggist” plays a patient with chronic granulocytic leukemia, which is treated primarily with a long-term oral targeted drug, just as patients with hypertension need long-term oral antihypertensive drugs, and most patients do not need a transplant. However, when targeted drugs are not effective or disease progression has occurred, allogeneic hematopoietic stem cell transplantation needs to be considered.
Chronic lymphocytic leukemia usually progresses slowly, and a significant proportion of patients do not need treatment immediately after diagnosis and may not need to start treatment until many years after diagnosis, mostly with chemotherapy or oral targeted agents, with a small number of refractory, relapsed patients requiring consideration of transplantation.
So, having leukemia does not necessarily require a bone marrow transplant; it is a combination of the type of leukemia and the effectiveness of treatment.
At present, bone marrow transplantation remains the only way to obtain a cure for some leukemia patients, especially those who are at high risk, refractory, or relapsed. For this group of patients, early pre-transplant HLA matching and donor physicals are required to prepare for transplantation.