Autologous (self) 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 majority of people with lymphoma receive an autologous stem cell transplant. In an autologous stem cell transplant, the stem cells are harvested from the person’s own body. Autologous transplants are preferable in most cases because they will not attack the body. The risk with autologous stem cell transplants is that the peripheral blood stem cells may be contaminated with lymphoma cells, which may contribute to a later relapse.

Less commonly, an allogeneic transplant may be considered. In an allogeneic transplant, stem cells are harvested from a donor who is usually a sibling or other close blood relative of the recipient. 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 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.

Eligibility criteria for stem cell transplants varies between countries and individual hospitals. In general, people may be considered ineligible for stem cell transplants if they are over 77 years of age, have cirrhosis of the liver, or have heart disease or another condition severe enough to limit their ability to perform self-care and participate in normal daily activities.

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

Peripheral blood stem cells are harvested before chemotherapy or early in the cycle of chemotherapy, and before radiation. The cells are then stored frozen until they are needed for the autologous stem cell transplant.

Stem cell transplants may be administered early – as soon as 24 hours after chemotherapy is complete – or reserved for later use until a relapse occurs. Some people with lymphoma receive two separate autologous stem cell transplants – known as double or tandem transplants – six to 12 months apart. Studies indicate that tandem transplants can provide greater benefits to some people with lymphoma but may also cause more intense side effects.

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 autologous 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.

In some people, lymphoma fails to respond to stem cell transplant and begins to progress 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...

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