Non-Hodgkin Lymphoma Overview

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Treating Non-Hodgkin Lymphoma TOPICS

Bone marrow or peripheral blood stem cell transplant for non-Hodgkin lymphoma

Stem cell transplants are sometimes used to treat lymphoma patients who are in remission (that is, they seem to be disease-free after treatment) or who have had the cancer come back (relapse) during or after treatment.

In a stem cell transplant, doctors give higher doses of chemotherapy (chemo) than would normally be safe. Giving high-dose chemo destroys the bone marrow, which prevents new blood cells from being made. This could normally lead to life-threatening infections, bleeding, and other problems due to low blood cell counts. To get around this problem, after chemo (and sometimes radiation treatment) is finished, the patient gets an infusion of blood-forming stem cells to restore the bone marrow. Blood-forming stem cells are very early cells that can make new blood cells. They are different from embryonic stem cells.

Types of transplants

There are 2 main types of stem cell transplants. The difference is the source of the blood-forming stem cells.

Autologous stem cell transplant: For this type of transplant, blood-forming stem cells from the patient's own blood or, less often, from the bone marrow, are removed, frozen, and stored until after treatment. Then the stored stem cells are thawed and given back to the patient through a vein. The cells enter the bloodstream and return to the bone, replacing the marrow and making new blood cells.

This is the most common type of transplant used to treat lymphoma, but it generally isn't an option if the lymphoma has spread to the bone marrow or blood. If that happens, it may be hard to get a stem cell sample with no lymphoma cells in it.

Donor (allogeneic) stem cell transplant: In this approach, the stem cells come from someone else – usually a matched donor whose tissue type is very close to the patient's. The donor may be a brother or sister or someone not related to the patient. Sometimes umbilical cord stem cells are used.

This type of transplant is not used a lot in treating non-Hodgkin lymphoma (NHL) because it can have severe side effects that are especially hard for patients who are older or who have other medical problems. And it is often hard to find a matched donor.

"Mini transplant": Many older patients can't have a regular allogeneic transplant that uses high doses of chemo. But some may be able to have what is called a "mini transplant" (or a non-myeloablative transplant or reduced-intensity transplant). For this type of allogeneic transplant, lower doses of chemo and radiation are used so they do not destroy all the stem cells in the bone marrow. The patient is then given the donor stem cells. These cells enter the body and form a new immune system, which sees the cancer cells as foreign and attacks them (called a "graft-versus-lymphoma" effect).

Patients can often do a mini transplant as an outpatient. But this is not yet a standard part of the treatment for most types of lymphoma.

Some things to keep in mind

Stem cell transplant is a complex treatment, so it is important to have it done at a hospital where the staff has experience with the procedure. Some transplant programs may not have experience in certain transplants, especially those from unrelated donors.

Stem cell transplant is very expensive. It can cost well over $100,000 and often involves a long hospital stay. Autologous transplant is considered a standard treatment for lymphoma under certain conditions, so most medical insurance will cover the cost. But some insurance companies see other types of stem cell transplants as experimental, and they might not pay for it. Even if the transplant is covered by your insurance, your co-pays or other costs could easily amount to tens of thousands of dollars. It is important to find out what your insurance will cover and what you might have to pay before deciding to have a transplant.

Possible side effects

The short-term side effects of stem cell transplant can be severe. They can include low blood cell counts (with increased risks of infection and bleeding), nausea, vomiting, loss of appetite, mouth sores, diarrhea, and hair loss.

One of the most common and serious short-term effects is the increased risk of infection. Antibiotics are often given to try to prevent this. Other side effects, like low red blood cell and platelet counts, may mean that you will need blood product transfusions or other treatments.

There are also many side effects that can last for a long time, or that may not happen until years after the transplant. Some of the more serious long-term side effects include:

  • Graft-versus-host disease (GVHD), which occurs only in a donor (allogeneic) transplant (see below)
  • Infertility
  • Damage to the lungs, causing shortness of breath
  • Bone damage (if damage is severe, the patient may need to have part of the bone and joint replaced)
  • Getting leukemia several years later

Graft-versus-host disease is a major problem of a donor (allogeneic) stem cell transplant. It happens when the donor cells multiply and start attacking the patient's tissues and organs.

Symptoms can include severe skin rashes with itching and severe diarrhea. The liver and lungs may also be damaged. The patient may also become tired and have aching muscles. Drugs that weaken the immune system may be given to try to control it, but they have their own side effects. On the plus side, this disease may also cause any remaining lymphoma cells to be killed by the donor immune system. Mild graft-versus-host disease can be a good thing, but severe cases can be fatal.

To learn more about stem cell transplants, see our document Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants).


Last Medical Review: 04/18/2013
Last Revised: 04/18/2013