People whose disease is not cured with initial treatment or who get recurrent lymphoma may have a bone marrow transplant in combination with chemotherapy, radiation, targeted therapies, or other new treatments being studied.
Getting a Bone Marrow Transplant for Lymphoma
In a bone marrow or stem cell transplant, immature blood cells (stem cells) are collected from the bone marrow or blood of the transplant patient (you) or a donor. These cells are frozen and stored. Then you undergo conditioning—receiving chemotherapy, with or without radiation therapy, to attack your cancer cells, destroy or suppress your immune system, and prevent your body from forming new blood cells.
Once conditioning is completed, the stored stem cells are thawed and injected into your bloodstream through a vein. This allows doctors to use higher doses of chemotherapy and radiation than would normally be used to fight lymphoma because the transplant restarts your stem-cell production.
The process for getting a bone marrow transplant is a long one, from early planning all the way through long-term follow-up care. Some of your care will take place at the Seattle Cancer Care Alliance (SCCA) Transplant Clinic, and some may take place at University of Washington Medical Center. For details see the Fred Hutchinson Transplant program at SCCA.
Types of Transplants
Most transplant recipients with non-Hodgkin’s lymphoma have a transplant using their own stem cells, called an autologous transplant. Using your own stem cells is usually not an option if the lymphoma is very aggressive and chemotherapy has not been effective in shrinking the tumors. In those cases, patients have a transplant using cells from a donor, called an allogeneic transplant. To avoid problems with your body rejecting the transplant, the donor’s tissue type must match yours as closely as possible. Often a close relative is the donor, but good matches also can be found using donor registries (people who have volunteered to be donors).
A variation of an allogeneic transplant is the reduced-intensity transplant (also called a non-myeloablative transplant or mini-transplant). This uses lower doses of chemotherapy and radiation to kill cancer cells and to weaken, but not destroy, your bone marrow and immune system. After you receive chemotherapy and radiation, the donor’s stem cells are infused into your bloodstream. The goals are for the new, transplanted immune system to attack any remaining cancer cells and to take over your weakened immune system completely as time goes on.
In some cases, an autologous transplant significantly shrinks tumor size but does not eradicate the lymphoma. Those patients may receive an allogeneic transplant as well, which is more effective at killing all lymphoma cells.
Transplants an Option for More Patients
Fred Hutchinson Cancer Research Center, an SCCA founding organization, pioneered the use of bone marrow transplants as a treatment for blood diseases more than 40 years ago. Since then, SCCA doctors have performed more transplants than doctors at any institution in the world, and great strides now make this treatment available to many more people.
Today, lower-dose conditioning reduces toxicity and complications and allows transplants to be offered to people in their 60s and 70s—those with the greatest incidence of lymphomas.
For patients who need donor cells and don’t have a family member or unrelated donor who is a close match, transplants are possible using stem cells from donated umbilical cord blood and from donors who only half-match your tissue type (haploidentical transplant).
Supportive and Follow-Up Care After Transplant
Chemotherapy and radiation before the transplant greatly weaken your immune system, and you will be very susceptible to infections. You may also have other side effects, like nausea, fatigue, and skin changes. Your health care team will teach you and your caregiver how to take special precautions to help prevent infections and how to manage side effects. They’ll also give you medicines to help with this. We’ll closely monitor you and treat you for any side effects or complications that arise. Your transplant team and caregiver will provide supportive medical care as well as emotional support.
SCCA provides lifelong support to patients following a bone marrow or stem cell transplant through the Long-Term Follow-Up (LTFU) program.