High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma
Stem cell transplants are sometimes used to treat lymphoma patients who are in remission or who have a relapse during or after treatment. Although only a small number of patients with lymphoma are treated with this therapy now, this number is growing.
Stem cell transplants allow doctors to use higher doses of chemotherapy (chemo) to kill the cancer than normally would be tolerated. Radiation is sometimes given as well. This treatment can kill the cancer cells but also destroys the bone marrow, which prevents new blood cells from being formed. This would be fatal if stem cells weren’t given back to replace the ones in the bone marrow. The stem cells used for the transplant can come from blood, bone marrow, or umbilical cord blood. In most cases, stem cells from the blood are used.
There are 2 main types of stem cell transplants (SCTs) based on the source of the stem cells. In an autologous SCT, the patient’s own stem cells are used. In an allogeneic transplant, the stem cells come from someone else (a donor). The donor’s tissue type (also known as the HLA type) needs to match the patient’s tissue type as closely as possible to help prevent the risk of major problems with the transplant.
Autologous SCTs are used more often than allogeneic to treat lymphoma. Still, using the patient’s own cells may not be an option if the lymphoma has spread to the bone marrow or blood. If that occurs, it may be hard to get a stem cell sample that is free of lymphoma cells.
The use of allogeneic transplants is limited in treating lymphoma because they can have severe side effects that make them hard to tolerate, especially for patients who are older or who have other medical problems. It can also be hard to find a matched donor.
Some patients may be able to be treated with a different type of allogeneic transplant in which lower doses of chemo and radiation are used than in a standard SCT. This is called a non-myeloablative transplant (or mini-transplant). In this kind of transplant, the chemo and radiation do not completely destroy the lymphoma cells. Instead, they are attacked by the new immune system that comes from the transplanted cells. A non-myeloablative transplant has less severe side effects from the chemo and radiation than a regular allogeneic transplant.
Non-myeloablative transplants are not a standard treatment for lymphoma, but they may help some patients.
Bone marrow or peripheral blood SCT is a complex treatment that can cause life-threatening side effects. If the doctors think a patient might benefit from a transplant, it should be done at a hospital where the staff has experience with the procedure and with managing the recovery phase. Some SCT programs may not have experience in certain types of transplants, especially transplants from unrelated donors.
SCT is very expensive (often costing well over $100,000) and often requires a long hospital stay. Autologous transplant is considered a standard treatment for lymphoma under certain conditions, so most medical insurance will cover the cost. Still, some insurance companies may view other types of SCT as an experimental treatment, and they may not pay for those procedures. Even if the transplant is covered by your insurance, your co-pays may be high. Find out what your insurer will cover before deciding on a transplant so you will have an idea of what you might have to pay.
Possible side effects
The early complications and side effects from a stem cell transplant are basically the same as those caused by any other type chemotherapy (see Chemotherapy for Non-Hodgkin Lymphoma), only they tend to be more severe.
One of the most common and serious short-term effects is the increased risk for infection. Antibiotics are often given to try to keep this from happening. Other side effects, like low red blood cell and platelet counts, may require blood product transfusions or other treatments.
One side effect that occurs is only seen with allogeneic transplants. It is called graft-versus-host disease, and it is caused by the donor cells attacking the patient’s own cells and tissues as foreign. This can be very serious and even life-threatening.
Symptoms can include severe skin rashes, itching, mouth sores (which can affect eating), nausea, and severe diarrhea. Liver damage may cause yellowing of the skin and eyes (jaundice). The lungs may also be damaged. The patient may also become easily fatigued and develop muscle aches.
Usually, immune-suppressing drugs can be used to help control GVHD, although they may have their own side effects.
For more information on these procedures, see Stem Cell Transplant for Cancer.
Freedman AS, Jacobson CA, Mauch P, Aster JC. Chapter 103: Non-Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Roschewski MJ, Wilson WH. Chapter 106: Non-Hodgkin Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: August 26, 2014 Last Revised: February 29, 2016
- Chemotherapy for Non-Hodgkin Lymphoma
- Immunotherapy for Non-Hodgkin Lymphoma
- Targeted Therapy Drugs for Non-Hodgkin Lymphoma
- Radiation Therapy for Non-Hodgkin Lymphoma
- High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma
- Surgery for Non-Hodgkin Lymphoma
- Palliative and Supportive Care for Non-Hodgkin Lymphoma
- Treating B-Cell Non-Hodgkin Lymphoma
- Treating T-Cell Non-Hodgkin Lymphomas
- Treating HIV-Associated Lymphoma
- What Should You Ask Your Doctor About Non-Hodgkin Lymphoma?