Stem cell transplant for childhood non-Hodgkin lymphoma
A stem cell transplant is sometimes used to treat childhood non-Hodgkin lymphoma (NHL). It is used to replace stem cells when stem cells or bone marrow are damaged. A stem cell transplant is a very risky and complex procedure that must be done in a specialized transplant centre or hospital.
Stem cells are found in the bone marrow, the bloodstream and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells.
A stem cell transplant uses high-dose chemotherapy to kill all of the cells in the bone marrow. This includes both healthy cells and the lymphoma cells. After high-dose chemotherapy, healthy stem cells are given to replace the ones in the bone marrow that were destroyed.
Your child may be offered a stem cell transplant to treat non-Hodgkin lymphoma if:
- the cancer does not respond to other treatments or is resistant to treatment
- the cancer comes back (recurs, or relapses) after treatment
A stem cell transplant is a complex procedure with many side effects and risks that must be done in specialized transplant centres or hospitals.
Types of transplants used for childhood NHL
The following types of stem cell transplant may be used with childhood NHL.
In this type of transplant, the stem cells are taken from the child’s own blood or bone marrow.
Autologous transplants are the most common type used to treat resistant or recurrent childhood NHL. Before the stem cells are collected, the doctor will do bone marrow aspiration and biopsy to make sure that there are no cancer cells in the bone marrow. Stem cells are usually collected from the peripheral blood through a special venous catheter, after recovery from a cycle of chemotherapy. The stem cells are then frozen until needed.
In an autologous stem cell transplant, very high doses of chemotherapy (conditioning) are used to try to kill any remaining cancer cells. The doses are so high that the child’s healthy bone marrow will not recover without being “rescued” by his or her previously collected healthy stem cells. These stem cells are given back to the child after the high-dose chemotherapy is complete.
In this type of transplant, the stem cells are taken from one person (the donor) and are given to the child receiving the transplant (the recipient). The donor may be a relative or may be unrelated to the child. The stem cells may either be collected from the donor’s bone marrow or peripheral blood or from an umbilical cord. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.
Allogeneic transplants may be used to treat certain types of relapsed childhood NHL. In addition to providing a “rescue” from very high doses of chemotherapy, the donor’s stem cells will often help fight lymphoma in the recipient (person receiving the stem cells), because they recognize the cancer cells as foreign.
Side effects can happen with any type of treatment for NHL, but every child’s experience is different.
Side effects can develop any time during, immediately after or a few days or weeks after a stem cell transplant. Sometimes late side effects develop months or years after a stem cell transplant. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of a stem cell transplant will depend mainly on the type of chemotherapy drug or drug combination given, if radiation therapy was given, the type of transplant and the child’s overall health. Common side effects of a stem cell transplant include:
- low blood cell counts
- graft-versus-host disease (GVHD)
- digestive system problems
Other side effects can develop months or years after treatment for childhood NHL. Find out more about late effects for childhood NHL.
Tell your child’s healthcare team if your child has side effects you think might be from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.
Questions to ask about stem cell transplant
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.