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Non-Hodgkin Lymphoma: Stem Cell Transplant

What is a stem cell transplant?

A stem cell transplant uses young blood cells, called stem cells, to replace bone marrow that has been destroyed by cancer treatment. Over time, these stem cells grow and become new, healthy bone marrow.

The bone marrow might be destroyed with high-dose chemotherapy. Or, this might be done with radiation to your whole body. This makes room for the healthy stem cells that are put back in your body. 

When might a stem cell transplant be used?

A stem cell transplant is a complex treatment. It can cause serious side effects. Because of this, it's most often used only when lymphoma is no longer responding to other treatments, or has come back after treatment.

Rarely, a stem cell transplant may be part of the first treatment for certain hard-to-treat types of lymphoma.

Types of stem cell transplants

There are 2 kinds of stem cell transplants:

  • Allogeneic transplant. This means the stem cells come from another person, called a donor, whose cell type is a lot like yours. A donor may be a close relative such as a brother or sister. Or, a stranger may match and be a donor.

  • Autologous transplant. This means the stem cells are collected from your own body and frozen. This is done before you get chemotherapy.

Autologous transplants are often preferred over allogeneic transplants. This is because of the lower risk of serious side effects. But autologous transplants can have some possible problems. For instance, they may be a less likely to fully destroy the lymphoma cells. An allogeneic transplant is often done if an autologous transplant didn’t work. Discuss the risks and benefits of each with your doctor.

How stem cells are collected

Stem cells may be collected in one of these ways:

  • From the blood.  This is the most common source of stem cells for a transplant. You or your donor may get injections of a growth factor medicine for several days. This medicine helps stimulate stem cell production. The method for collecting stem cells from the blood is called apheresis. It’s a lot like giving blood, but it takes longer. A thin, flexible tube (catheter) is used to take out blood from a vein. The blood goes into a cell separation device that removes the stem cells. Then the rest of the blood is returned to you or the donor. You may have a strange taste in your mouth during this process. This is from the preservative used to save the stem cells. This process may need to be done more than once to collect the right amount of cells.

  • From the bone marrow.  Stem cells may also be taken from your bone marrow. Or they may be taken from your donor’s bone marrow. This is done while medicines are used to put you or your donor into a deep sleep. A doctor makes a few small holes in the back of the pelvic or hip bone to remove marrow. The hip bone may be sore for a few days afterwards. These stem cells are filtered and frozen until they are needed. This

  • From umbilical cord blood.  Stem cells may also be collected from umbilical cord blood. After a baby is born, the blood from the placenta and umbilical cord is collected. This blood has a lot of stem cells in it. The blood is frozen and stored until it's needed by someone with a matching tissue type.

Having the transplant

  • You might need to be in the hospital for the transplant. Your doctor or nurse will go over the procedure with you. They will also talk about ways to lower your risk for infections. 

  • You'll get high-dose chemotherapy or radiation. It may last several days.

  • After this treatment, you'll get the stem cells through an IV or intravenous line that’s attached to a tube. This is a lot like a blood transfusion. The stem cells will go to your bone marrow. There, they start to multiply and make new blood cells.

  • You will have to wait for your stem cells to start multiplying. This process is called engraftment. You may have to limit your time around other people during this time to help keep you from getting an infection. 

  • You will see your treatment team every day for the first month or so. They will watch your blood counts closely. You may need antibiotics, platelets, or blood transfusions until the new stem cells start to work.

Sometimes the cancer comes back (relapses) after transplant. If you had an allogeneic transplant, you might be able to get a treatment called DLI, or donor lymphocyte infusion, after transplant. DLI is done by removing a type of white blood cell called lymphocytes from the stem cell donor’s blood and freezing them. The lymphocytes are later thawed. They're given to you in 1 or more infusions. The donor’s lymphocytes will see any lymphoma cells that are left as not belonging to your body and will attack these cells.

Side effects

Short-term side effects

Most of the short-term side effects of a stem cell transplant are from the high doses of chemotherapy or radiation. These should go away as you recover from the transplant. Common side effects include:

  • Low blood cell counts

  • Infection

  • Feeling tired

  • Easy bruising and bleeding

  • Upset stomach, or nausea

  • Vomiting

  • Loss of appetite

  • Mouth and throat sores

  • Diarrhea

  • Hair loss

  • Fever or chills

  • Shortness of breath

  • Tightness or pain in the chest

  • Pneumonia or other lung problems

  • Low blood pressure

  • Coughing

  • Weakness

  • Acute graft-versus-host disease (see below)

Long-term side effects

Some side effects of a stem cell transplant may be long-lasting or not show up until years later, such as:

  • Shortness of breath, often caused by radiation damage to the lungs

  • Lack of menstrual periods, which may mean ovary damage and infertility

  • Infertility in men

  • Weight changes

  • Vision problems such as blurriness or cloudiness, caused by damage to the lens of the eye (cataracts)

  • Bone pain, caused from damage due to lack of blood supply (called aseptic necrosis)

  • Problems with metabolism, caused by damage to the thyroid gland

  • Damage to other organs, such as the heart, kidneys, and nervous system

  • Another cancer, such as leukemia, years later

Graft-versus-host disease (GVHD)

Another possible side effect is graft-versus-host disease (GVHD). This can only occur with an allogeneic transplant. It can happen a few weeks after transplant. Then it's called acute GVHD. Medicines are often used to help prevent or limit this. Chronic GVHD starts later, usually more than 3 months after transplant. When this happens, medicines that suppress your immune system may be needed until the symptoms get better.

In GVHD, the immune system cells in the donor's stem cells attack your body. The cells can attack your skin, liver, gastrointestinal tract, mouth, or other organs. This can cause symptoms such as:

  • Skin rashes and redness with itching (most common sign), the rash can be everywhere, including your hands and the soles of your feet

  • Upset stomach, or nausea

  • Vomiting

  • Mouth sores

  • Belly cramps and swelling

  • Severe watery diarrhea

  • Appetite loss

  • Extreme tiredness, or fatigue

  • Yellow-colored skin and/or eyes, called jaundice

  • Muscle pain

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham RN BSN
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 12/1/2019
© 2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.