Stem cell transplantation

Stem cell transplants are sometimes used to treat lymphoma patients who are in remission (seem to be disease-free after treatment) or who have the lymphoma come back (relapse) during or after treatment.
Standard doses of chemo drugs can cause serious side effects to tissues that divide fast, such as the cells in the bone marrow. Although even higher doses of these drugs might work better to treat Hodgkin disease, they are not given because the severe damage to bone marrow cells would cause lethal shortages of blood cells, and other vital organs would likely be damaged too.
But sometimes Hodgkin disease does not respond well to standard treatment, or the disease comes back after treatment. In these cases, a stem cell transplant (SCT) allows doctors to use higher doses of chemo. After chemo treatment, the patient gets a transplant of blood-forming stem cells to restore the bone marrow.

Autologous Stem Cell Transplant

This type of transplant uses blood-forming stem cells from the patient’s own blood or, less often, from the bone marrow. The stem cells are removed, frozen, and stored. Then very high doses of chemo (with or without radiation treatment) are given in order to kill the cancer. These high doses destroy bone marrow, too. When this happens, the body is no longer able to make new blood cells. So, after the treatment, the stored stem cells are thawed and put back into the patient’s bloodstream through a vein. Over time the stem cells return to the bone, replacing the marrow and making new blood cells.
If this type of transplant fails, then a matched donor might supply the stem cells. When the stem cells come from someone else, it is called an allogeneic stem cell transplant.

The Transplant Process

The treatment works like this: Stem cells are collected from the bloodstream in a process calledapheresis. The cells are frozen and stored. Patients are then given very high doses of chemo to kill the cancer cells. The patient might also get total body radiation to kill any remaining cancer cells that the chemo may not have killed. After treatment, the stored stem cells are given to the patient like a blood transfusion. The stem cells settle into the patient’s bone marrow over the next several days and start to grow and make new blood cells.
People who get a donor’s stem cells are given drugs to prevent rejection. Usually within a couple of weeks after the stem cells are given, they start making new white blood cells. Then they begin making platelets, and finally, red blood cells.
Patients having SCT have to be kept away from germs as much as possible until their white blood cell count is at a safe level. They are kept in the hospital until the white cell count reaches a certain number, usually around 1,000. After they go home, they will be seen as an outpatient regularly for about six months.

Side Effects of Stem Cell Transplant

Side effects from stem cell transplant can be divided into short- and long-term effects. The short-term or early side effects are about the same as those caused by any other type of high-dose chemo. One of the most common and serious short-term effects is the greater risk of infection. Other side effects include low red blood cell counts, nausea, vomiting, loss of appetite, mouth sores, and hair loss.

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