Stem cell transplant for non-Hodgkin lymphoma

Stem cells are unspecialised cells from which blood cells develop. Most stem cells are found in the bone marrow, but a small number are also found in the blood – these are called peripheral blood stem cells.

If non-Hodgkin lymphoma returns (recurs) or does not respond to initial treatment, you may need high doses of chemotherapy to help destroy the cancer cells. This can also damage the stem cells, and you may need a stem cell transplant to help restore the bone marrow and rebuild your immune system.

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Types of transplant

A transplant is done in several stages and the entire procedure, including recovery, can take months. There are two main types:

Autologous transplant – when your stem cells are removed from your blood and later transplanted (reinfused) back into your body. This is the most common type of transplant recommended to treat non-Hodgkin lymphoma.

Allogeneic transplant – when the stem cells are collected from another person (a donor). This type of transplant is less commonly used as a treatment for non-Hodgkin lymphoma.

A stem cell transplant is a major procedure and not all people are suitable candidates. Your doctors will talk to you about what is involved. You will also have a range of tests to assess your ability to handle the transplant process and tolerate the high-dose chemotherapy.


Autologous stem cell transplant steps

This is a general outline of a transplant using your own stem cells. The process varies from person to person. Talk to your health care team about what to expect.

Here are the steps:

  1. Mobilising stem cells
    • The first stage is to stimulate the production of stem cells.
    • You will usually be given a dose of chemotherapy before having injections of a special growth factor drug called granulocyte-colony stimulating factor (G-CSF).
    • G-CSF can cause bone pain. Ask your health care team about pain-relieving medicine.
    • You will be given G-CSF for 5–10 days to help the stem cells in the bone marrow multiply as quickly as possible. When the bone marrow is full of stem cells, excess stem cells will spill into the blood. This process, called mobilisation, takes several days.
    • You will have regular blood tests to check whether there are enough stem cells in your blood.
  2. Collecting and storing stem cells
    • When enough stem cells are in your blood, they will be collected in a cell-separating machine. This process is called apheresis.
    • The machine separates the blood – the white blood cell layer containing the stem cells is collected and the remaining blood is returned to your body.
    • Generally, a needle will be inserted into each arm. One needle will draw the blood out of your body and into the machine for separation. The other needle will return the remaining blood to your body.
    • In some people, blood will be taken from a vein in the neck or chest using a catheter.
    • Blood is removed and returned to your body continuously for 3–4 hours. Only a small amount of blood will be out of your body at any time.
    • The stem cells are processed and frozen using liquid nitrogen (cryopreserved).
    • You will then have a rest period at home for about a month before the next stage.
  3. Receiving high-dose chemotherapy
    • In the week before the transplant, you’ll have high-dose chemotherapy to kill any remaining cancer cells.
    • Before and after the chemotherapy is given, you will have fluids through a drip to prevent dehydration and kidney damage.
    • You may experience side effects from the chemotherapy, such as nausea, diarrhoea and mouth sores.
    • The chemotherapy will also destroy the stem cells in your bone marrow, which can cause side effects.
    • Because your stem cells have been destroyed, your blood count will be low and you will be more at risk of infections.
  4. Transplanting stem cells and engraftment
    • A day or so after high-dose chemotherapy, your frozen stem cells are thawed and put back into your body (reinfused) using a drip. This process is similar to a blood transfusion and takes about an hour.
    • You may have stomach cramps and feel nauseous, which can be managed with medicines.
    • The healthy stem cells will travel via your bloodstream into your bone marrow, to restore the stem cells destroyed by the chemotherapy.
    • This is called engraftment and it takes about 10–14 days.
    • During this time, you may receive further injections of G-CSF to help the white blood cells recover.

More detailed information about stem cell transplants is available at leukaemia.org.au.

Sometimes the stem cells will be collected directly from the bone marrow by suction (aspiration) under general anaesthetic. This is called a bone marrow harvest. This is not a common procedure.

Recovery and side effects after a transplant

After the stem cell transplant, you will be in hospital for about 1–4 weeks, depending on the type of transplant you have, whether it is done as an outpatient or inpatient procedure, whether you have any other health problems, and the side effects that you experience. You will be able to leave hospital once your blood counts have returned to safe levels.

After the chemotherapy and transplant, you will have a low blood count. This will lower your immunity and make you more likely to get infections. You may be given antibiotics to treat infections, and will need to avoid contact with people with a cold, flu or other contagious infection. See Taking care with infections for some ways to reduce your risk.

Your blood counts and general health will be monitored regularly by your doctor after the transplant. You may need occasional blood and platelet transfusions for a short period after the transplant.

Many transplant side effects are similar to the side effects of chemotherapy. Occasionally they can be more severe. Side effects may include: nausea and vomiting; diarrhoea; hair loss; infection; mouth ulcers; fatigue; and poor appetite.

Your doctor and nurses will help you manage any side effects you experience after a stem cell transplant.

You will need regular follow-up care to check your progress and how well the treatment has worked. It is not uncommon to become unwell after a transplant and have to go back into hospital. The time it takes to fully recover from a transplant varies. Talk to your health care team about what to expect while you recover. You can also call Cancer Council 13 11 20 for support.


This information was last reviewed in December 2017
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