About Lymphoma

Stem cell transplants

There are two main types of transplants, autologous and allogeneic stem cell transplants.

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Transplants in lymphoma fact sheet

Dr Nada Hamad, Haematologist & bone marrow transplant physician
St Vincent’s Hospital, Sydney

What is a stem cell?

A stem cell is an immature undeveloped blood cell in the bone marrow that has the potential to become any type of blood cell that the body needs. A stem cell will eventually develop into a mature differentiated (specialised) blood cell. There are three main types of blood cells which stems cells can develop into that include:
  • White blood cells (including lymphocytes – which are the cells that when turn cancerous cause lymphoma)
  • Red blood cells (these are responsible for carrying oxygen around the body)
  • Platelets (the cells that help blood to clot or to prevent clots)
The human body makes billions of new haematopoietic (blood) stem cells every day to replace its naturally dead and dying blood cells.

What is a stem cell transplant?

A stem cell transplant is a procedure that may be used to treat lymphoma. They can be used to treat patients whose lymphoma is in remission but there is a high chance the lymphoma will relapse (comes back). They may also be used to treat patients whose lymphoma has relapsed (come back).

A stem cell transplant is a complicated and invasive procedure that occurs in stages. Patients undergoing a stem cell transplant are first prepared with chemotherapy alone or in combination with radiotherapy. The chemotherapy treatment used in stem cell transplants is given at higher doses than usual. The choice of chemotherapy given in this stage depends on the type and intent of the transplant. There are three places that stem cells for transplant can be collected from:

  1. Bone marrow cells: stem cells are collected directly from the bone marrow and are called a ‘bone marrow transplant’ (BMT).

  2. Peripheral stem cells: stem cells are collected from peripheral blood and this is called a ‘peripheral blood stem cell transplant’ (PBSCT). This is the most common source of stem cells used for transplantation.

  3. Cord blood: stem cells are collected from the umbilical cord after the birth of a newborn. This is called a ‘cord blood transplant’, where these are much less common than peripheral or bone marrow transplants.

     

Types of stem cell transplants

There are two main types of transplants, autologous and allogeneic stem cell transplants.

Autologous stem cell transplants: this type of transplant uses the patient’s own stem cells, which are collected and stored. You will then have high doses of chemotherapy and following this your stem cells will be given back to you.

Allogeneic stem cell transplant: this type of transplant uses donated stem cells. The donor may be related (a family member) or an unrelated donor. Your doctors will try and find a donor whose cells closely match the patient. This will reduce the risk of the body rejecting the donor stem cells. The patient will have high doses of chemotherapy and sometimes radiotherapy. Following this the donated stem cells will be given back to the patient.

For more detailed information on each of these types of transplants, see autologous transplant or allogeneic transplant pages.

Indications for a stem cell transplant

Dr Amit Khot, Haematologist & bone marrow transplant physician
Peter MacCallum Cancer Centre & Royal Melbourne Hospital

Most patients diagnosed with lymphoma do NOT need a stem cell transplant. Both autologous and allogeneic stem cell transplantation are only used in certain circumstances. The main indications for a stem cell transplant include:

  • If a lymphoma patient has refractory lymphoma (lymphoma that is not responsive to treatment) or relapsed lymphoma (lymphoma that keeps coming back after treatment).
  • The indications for an autologous transplant (own cells) are also different to the indications for an allogeneic (donor cells) transplant.
  • Lymphoma patients most commonly receive an autologous transplant rather than an allogeneic transplant. An autologous transplant has less risks and less complications and generally is successful in treating the lymphoma.

Indications for an autologous (own cells) stem cell transplant include:

  • If the lymphoma relapses (comes back)
  • If the lymphoma is refractory (does not respond to treatment)
  • Some patients who are diagnosed with a lymphoma that is known to have a high chance of relapse, or if the lymphoma is particularly advanced stage, will be considered for an autologous transplant as part of the initial treatment plan.

Indications for an allogeneic (donor) stem cell transplant include:

  • If the lymphoma relapses after an autologous (own cells) stem cell transplant
  • If the lymphoma is refractory
  • As part of the second- or third-line treatment for relapsed lymphoma/CLL

The transplantation process

Dr Amit Khot, Haematologist & bone marrow transplant physician
Peter MacCallum Cancer Centre & Royal Melbourne Hospital

There are five major steps that are involved in a transplant:

  1. Preparation
  2. Collection of stem cells
  3. Conditioning
  4. Reinfusing stem cell
  5. Engraftment

The process for each type of transplant can be very different. To find out more information:

Dr Amit Khot, Haematologist & bone marrow transplant physician
Peter MacCallum Cancer Centre & Royal Melbourne Hospital

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