Allogeneic (donor) stem cell transplant for Lymphoma

Overview
Stem cell transplant after high-dose chemotherapy is sometimes used to treat people with lymphoma. The purpose of a stem cell transplant in lymphoma is to compensate for higher doses of chemotherapy that will destroy bone marrow. Transplanted stem cells will form healthy bone marrow. Stem cell transplants usually take place after cancerous cells have been destroyed with chemotherapy, radiation, or a combination of the two. In some cases, stem cell transplant can be part of treatment that provides long-term remission or even cures lymphoma.

The vast majority of people with lymphoma who undergo stem cell transplant receive an autologous stem cell transplant, which means that the stem cells are harvested from their own bodies. The risk of severe side effects is lower with autologous stem cell transplants. However, people with lymphoma who receive autologous stem cell transplants are more likely to experience a relapse since lymphoma cells may be present among the transplanted stem cells.

Less commonly, an allogeneic transplant may be considered. Allogeneic stem cell transplants may be considered in cases of Hodgkin lymphoma when autologous stem cell transplant has failed, or in cases of non-Hodgkin lymphoma (NHL) when cancer has spread to the blood or bone marrow. In an allogeneic transplant, stem cells are harvested from a donor who may be a sibling or other close blood relative of the recipient or an unrelated person who is a good genetic match.

Allogeneic stem cell transplants carry a significant risk of life-threatening side effects. Due to the risk of severe side effects, allogeneic stem cell transplant is most likely to be considered in cases involving younger people with relapsed myeloma that is considered high-risk based on genetic characteristics. Allogeneic stem cell transplant may be considered after an autologous stem cell transplant has failed.

In the past, cells for transplant were taken from bone marrow. For this reason, some people still refer to stem cell transplants as bone marrow transplants. However, blood is now the most common source for hematopoietic (blood cell producing) stem cells for transplant in cases of lymphoma. Stem cells sourced from the blood may be referred to as peripheral blood stem cells.

What does it involve?
Most people with lymphoma undergo a course of chemotherapy, radiation, or both prior to receiving a stem cell transplant.

Stem cells are usually harvested from a donor who is a close blood relative, but the donor may also be someone unrelated who is a good genetic match. Ideally, allogeneic stem cell transplants will trigger a process known as graft-versus-tumor or graft-versus-lymphoma effect in which the transplanted cells help attack the cancer cells.

However, the greater risk of graft-versus-host disease (GVHD) often outweighs this potential benefit of allogeneic stem cell transplant. In GVHD, the transplanted donor cells attack the host’s tissues. Graft-versus-host disease ranges from mild to potentially life-threatening. Acute GVHD is very dangerous and must be treated with powerful immunosuppressant medications such as corticosteroids. Chronic GVHD may also threaten life, but in milder cases, chronic GVHD may cause limited symptoms and improve overall survival in people who receive allogeneic stem cell transplant for lymphoma.

The process of receiving a stem cell transplant is similar to receiving a blood transfusion. Stem cell transplants for lymphoma may be administered on an outpatient or inpatient basis. The majority of people will be admitted to the hospital during the stem cell transplant process. Those admitted to the hospital for stem cell transplant can expect to stay two to three weeks during recovery.

During the first weeks of recovery from stem cell transplant, people with lymphoma may receive antibiotics and antiviral or antifungal medications to help protect them against infection. They may also require transfusions of red blood cells or platelets (cell fragments involved in the clotting process) to replace those destroyed by chemotherapy. Those who have undergone stem cell transplant for lymphoma may also be given hematopoietic growth factors – substances that encourage and speed the growth of blood cells.

After receiving a stem cell transplant, most people with lymphoma will receive two to three years of maintenance medications to sustain the treatment response.

Intended Outcomes
Stem cell transplant can extend survival and reduce symptoms in people diagnosed with lymphoma.

Results
The effectiveness of allogeneic stem cell transplant for lymphoma depends on many factors, including the type and stage of lymphoma, specific genetic characteristics of lymphoma cells, and other treatments that are used before, during, and after stem cell transplant.

Constraints
Short-term side effects of stem cell transplant can include fatigue, headaches, fever and chills, nausea, vomiting, diarrhea, loss of appetite, weight loss, trouble sleeping, and skin rashes. Some people develop mucositis, inflammation of the digestive tract that can cause pain and make it difficult to eat. Some side effects, such as nausea, can be eased with other medications. Fatigue may be longer-lasting, persisting beyond the immediate recovery period. It may take months to fully recover after receiving a stem cell transplant.

For people who receive allogeneic stem cell transplants, the threat of graft-versus-host disease never fully disappears. Those who receive allogeneic stem cell transplants and show signs of GVHD may need to take immunosuppressant medications throughout their lives. Chronic GVHD can cause symptoms that affect the eyes, lungs, liver, digestive tract, genitals, and skin, hair, or nails. In severe cases, GVHD can be fatal.

In some people, lymphoma fails to respond to stem cell transplant and relapses soon after the transplant.

For more details about this treatment, visit:
High-dose Chemotherapy and Stem Cell Transplant for Hodgkin Lymphoma – American Cancer Society
https://www.cancer.org/cancer/hodgkin-lymphoma/...

High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma – American Cancer Society
https://www.cancer.org/cancer/non-hodgkin-lymph...

Stem Cell Transplantation – Leukemia & Lymphoma Society
https://www.lls.org/treatment/types-of-treatmen...

Graft-Versus-Host Disease – Leukemia & Lymphoma Society https://www.lls.org/treatment/types-of-treatmen...

What are the Side Effects of a Stem Cell Transplant? – Dana-Farber Cancer Institute https://blog.dana-farber.org/insight/2018/02/si...

The graft-versus-myeloma effect: chronic graft-versus-host disease but not acute graft-versus-host disease prolongs survival in patients with multiple myeloma receiving allogeneic transplantation. – The Biology of Blood and Marrow Transplantation https://www.ncbi.nlm.nih.gov/pubmed/24792872