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Stem cell transplant for Hodgkin lymphoma
A stem cell transplant may be used to treat Hodgkin lymphoma (HL). A stem cell transplant replaces a person’s stem cells. It is used to restore bone marrow when it has been damaged by disease or destroyed by high doses of chemotherapy or radiation therapy. A stem cell transplant may also be called a bone marrow transplant.
Stem cells are the basic cells from which all our blood cells develop. They are found in the bone marrow and in the bloodstream.
At one time, the bone marrow was the most common source of stem cells for transplant (bone marrow transplant). Now, blood is being used more often as the source of stem cells (peripheral stem cell transplant).
Stem cell transplants may be considered for people with HL in the following cases:
- when the HL is not responding to other treatments or standard treatment has failed to work (refractory disease)
- if the HL comes back after an initial response to treatment (relapsed disease)
Types of transplants
There are 3 basic types of stem cell transplants that may be used with HL.
The stem cells are taken from the person’s own bone marrow or blood. An autologous transplant is the most common type done for HL. (Many people with HL cannot have an allogeneic stem cell transplant using stem cells from a donor because it can be difficult to find a match.)
There are advantages to having an autologous stem cell transplant, such as avoiding graft-versus-host disease and not needing to find a donor. However, an autologous transplant may not be possible for some types of lymphoma that have spread to the bone marrow or blood because it can be difficult to get stem cells that are free of lymphoma. Some people with HL who have an autologous stem cell transplant will relapse after the transplant.
The stem cells are taken from one person (donor) and are given to another person (recipient). A donor may be a relative or an unrelated person. The donor and recipient are matched through a process called HLA typing.
One benefit of having an allogeneic transplant is the graft-versus-lymphoma effect, in which the donor cells attack remaining cancer cells in the recipient. However, there are more side effects associated with an allogeneic transplant than with an autologous transplant.
It is often hard to find a matched donor for an allogeneic transplant. The side effects of this type of transplant can also be very hard on older people. Therefore, this type of transplant may not be done as often for HL.
The stem cells are taken from a donor who is the identical twin of the recipient. This is an uncommon type of transplant.
A stem cell transplant is a complex procedure. For this reason, stem cell transplants are done in specialized transplant centres or hospitals by a team of highly trained healthcare professionals.
The day the stem cells are given is usually referred to as Day 0. The days after transplant are numbered upward (for example, Day 1, Day 2 and so on). This system is useful to describe the timing of events, such as when new blood cells begin to appear (engraftment) or complications of the procedure occur.
There are 3 stages in a stem cell transplant procedure.
Before the stem cell transplant, some procedures are done to check that the recipient is a good candidate. Stem cells are collected for the transplant (called harvesting).
The stem cell transplant procedure has 2 steps:
- conditioning or intensive therapy – High-dose chemotherapy alone or with radiation therapy is given to:
- “condition” the person’s bone marrow to accept donor stem cells (allogeneic or syngeneic transplant)
- remove any remaining cancer cells in the body (autologous transplant)
- destroy the bone marrow and make room for new stem cells
- giving the stem cells – The stem cells are given (infused) to the person over 1–2 hours through a central venous cathetercentral venous catheterA catheter (flexible tube) that is passed through a vein in the neck, groin or chest into the vena cava (the large vein leading into the heart)., similar to a blood transfusion.
A person is watched closely after a stem cell transplant. They are also carefully followed for a period of time after leaving the hospital. It may take several months to fully recover after a stem cell transplant.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.