Stem cell transplants for non-Hodgkin lymphoma
You might have a stem cell transplant as part of your treatment for non-Hodgkin lymphoma (NHL).
A stem cell transplant allows you to have high doses of chemotherapy. The chemotherapy kills the lymphoma cells. But it also damages the normal stem cells.
After the treatment, you have the new stem cells into your bloodstream through a drip. The new stem cells go to the 
. Your body can start making blood cells again as your bone marrow slowly recovers.
Depending on your situation, you might have a transplant using:
- your own stem cells
- stem cells from another person (a donor)
When you might have a stem cell transplant for NHL
The aim of NHL treatment is usually to put it into remission. Remission means there is no sign of lymphoma. You might have a stem cell transplant if your NHL:
- is in remission but is very likely to come back
- has come back after treatment and is in a second remission
- doesn’t respond to other treatment - doctors call this refractory NHL
High dose chemotherapy and a transplant aims to cure some types of NHL. Or it might control the lymphoma for longer if a cure is not possible. Your treatment plan and aims will depend on many factors. These include what type of NHL you have, and how far it has spread (the stage).
If you know what type of NHL you have, you can read more about your treatment options. You can select your type from the 'types of NHL' menu page.
What are stem cells?
Stem cells are very early cells made in the bone marrow. Bone marrow is a spongy material that fills the bones.
These stem cells develop into red blood cells, white blood cells and platelets.
Red blood cells contain haemoglobin which carries oxygen around the body. White blood cells are part of your immune system and help to fight infection. Platelets help to clot the blood to prevent bleeding.
Types of transplant
Depending on your situation, you might have a transplant using:
-
your own stem cells - this is called an autologous stem cell transplant
-
stem cells from another person (a donor) - this is called an allogeneic stem cell transplant
Autologous stem cell transplants
For NHL, you are more likely to have an autologous stem cell transplant.
You usually have an autologous transplant using stem cells collected from your bloodstream. This is called a peripheral blood stem cell transplant (PBSCT). Or you may have a transplant using stem cells collected from your bone marrow. This is called a bone marrow transplant.
PBSCT is more common than bone marrow transplants. This is because:
- it's easier to collect stem cells from the bloodstream than the bone marrow
- your treatment team can usually collect more cells
- your blood cell levels usually recover faster
Allogeneic stem cell transplants
Allogeneic stem cell transplants are less common for NHL. But there are certain situations when you might have an allogeneic stem cell transplant. For example, if your NHL comes back after an autologous stem cell transplant or CAR-T cell therapy.
You might have stem cells from:
- a brother or sister - this is called a sibling match
- a person unrelated to you whose stem cells are similar to yours - this is called a matched unrelated donor or MUD
Having a stem cell transplant
There are different stages of stem cell transplant:
- preparing for the transplant
- stem cell collection
- conditioning treatment
- having the stem cells
- blood count recovery
Preparing for a stem cell transplant
To prepare you for your transplant, you have:
- various tests
- a central line put in
A central line is a long plastic tube that goes into a large vein near the heart. Doctors and nurses use them for taking blood samples and giving drugs.
You might have chemotherapy to get rid of as many lymphoma cells as possible. This chemotherapy might also help the bone marrow make more stem cells.
Before an , you have growth factor injections. Growth factors are natural substances that make the bone marrow produce more stem and blood cells. Depending on your situation you have daily injections of growth factor for between 5 and 10 days.
If you are having an , your medical team look for and test possible donors.
Collecting stems cells
Before an autologous stem cell transplant, you usually go to the day care unit for the stem cell collection.
You have daily blood tests to see if there are enough stem cells in your bloodstream. When you are ready, you have the stem cell collection. Collecting the stem cells takes 3 or 4 hours. You are awake during this process.
To collect stem cells from your bone marrow, you have a . A doctor puts a needle into you hip bone to remove the bone marrow.
Your doctor freezes and stores your stem cells.
For an , you have stem cells from someone else. They are called the donor.
Your donor has injections of a growth factor if they are going to have stem cells collected from their bloodstream. The growth factor makes the stem cells spill out into the blood. When there are enough stem cells, the nurse collects these via a drip from their bloodstream.
Your donor has a general anaesthetic if the doctor is taking stem cells from their bone marrow. A doctor puts a needle into their hip bone to remove the bone marrow.
Conditioning treatment
You usually have high dose chemotherapy. This is called conditioning treatment. You might also have targeted drugs. This depends on your type of NHL. Some people have radiotherapy to their whole body. This is called total body irradiation or TBI.
You have chemotherapy and other drugs over about 5 or 6 days. If you have TBI, you might have it at the beginning or end of your chemotherapy.
If you are having an allogenic transplant, there are different strengths of conditioning treatment. The 2 main strengths are:
- full intensity (myeloablative) conditioning
- reduced intensity conditioning (RIC)
Full intensity or ‘myeloablative’ treatment involves high-doses of chemotherapy. You might also have radiotherapy.
Reduced intensity treatment involves lower doses of chemotherapy. You might have this if you are not fit enough to have full intensity treatment. The side effects are less severe.
The conditioning treatment you have depends on:
- what type of NHL you have
- whether you are having an autologous or allogenic stem cell transplant
- other factors such as how old you are and your general health
Your doctor will tell you more about what conditioning treatment you will have and how it might affect you.
Having the stem cells
After your high dose treatment, the nurse gives you the defrosted stem cells through a drip.
The cells flow through your central line into your bloodstream. You might need another small plastic tube in your vein called a cannula, if the cells don't flow easily.
You are awake while you have the drip. It's like having a blood transfusion. It usually takes a couple of hours at the most.
Blood count recovery
The stem cells find their way back into your bone marrow where they make the blood cells you need. This recovery of blood cells is called engraftment.
You have regular blood tests to check when your bone marrow starts to make new blood cells. The time it takes for the new blood cells to appear (and blood counts to recover) can vary. This may take a few weeks, although it can vary from person to person.
During this time, you continue to have treatment for any side effects and symptoms. This might include:
- antibiotics and antiviral medicines to treat and prevent infection
- platelet transfusions if the number of platelets in your blood are low
- blood transfusions if your red blood cells are low
- medicines to relieve a sore mouth, diarrhoea and sickness
You may stay in hospital until your blood cells have recovered enough to go home. And you no longer have any severe side effects.
Some people can go home straight after their stem cell transplant. This is more likely if you have a transplant using your own stem cells (autologous). You need to attend the hospital daily for blood tests and treatment. You only stay in hospital if you develop complications.
Outpatient transplant treatment is becoming more common.
Possible side effects
The possible side effects of having a stem cell transplant are usually caused by high dose chemotherapy. This is because the treatment lowers the number of your blood cells. Side effects include:
- increased risk of getting an infection
- tiredness and lacking energy
- increased risk of bleeding
- sickness
- loose or watery poo (diarrhoea)
- a sore mouth
- difficulty eating and drinking
After an allogeneic transplant, you can have a reaction. This is called graft verses host disease or GVHD. This is when the donor cells attack some of your own body cells.
Fertility
is a long term side effect of this type of treatment. This is due to the high doses of chemotherapy. Most people can no longer have children. This can be very difficult for some people to cope with.
Sometimes men and teenage boys can store sperm before they start their chemotherapy, so that they can still father a child in the future. This is called sperm banking. Ask your doctor if you think you would like to do this.
For women, chemotherapy can cause an early menopause. You might be able to have hormone replacement therapy to treat the symptoms of a menopause. Ask you doctor about this.
Sometimes women can freeze their eggs or embryos before they start treatment. Talk to your doctor early on if you want to find out more about this. It can take a few weeks and may delay your cancer treatment.
Recovery after a stem cell transplant
It takes a long time to get over intensive treatment such as a stem cell transplant. You might need to make adjustments in various parts of your life.
To begin with, you might still have low blood counts. Your doctors and nurses will give you guidance about what you should or shouldn't do, to help you stay well.
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