Stem cell and bone marrow transplants

Stem cell or bone marrow transplant is a way of giving very high dose chemotherapy. This treatment aims to cure some types of cancer, including Hodgkin lymphoma.

What is bone marrow

Bone marrow is a spongy material that fills the bones.

It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.

When you have a stem cell or bone marrow transplant

You have a stem cell or bone marrow transplant after very high doses of chemotherapy. The chemotherapy has a good chance of killing the cancer cells but also kills the stem cells in your bone marrow.

Before your high dose chemotherapy, your team collects your stem cells or bone marrow. Or they collect a donor's stem cells or bone marrow.  After the treatment you have the cells into a vein through a drip. The cells find their way back to your bone marrow. Then you can make the blood cells you need again. 

Why you might have a stem cell or bone marrow transplant

You might have this intensive treatment if your Hodgkin lymphoma comes back after the first course of treatment. It can get rid of the lymphoma again for many people. Your doctor might also suggest this treatment if your Hodgkin lymphoma has not responded to the standard treatment.

You might have a course of high dose BEAM or LEAM chemotherapy. Then most people with Hodgkin lymphoma have their own stem cells or bone marrow back after the high dose treatment. This is called an autologous transplant.

Stem cell transplant

You're now more likely to have a stem cell transplant (also called peripheral blood stem cell transplant) than a bone marrow transplant.

This is because:

• it's easier to collect stem cells from the blood than the bone marrow
• your treatment team can usually collect more cells
• your blood cell levels tend to recover faster

Collecting your stem cells

You have injections of growth factors before, and sometimes after, the stem cell transplant. Growth factors are natural proteins that make the bone marrow produce blood cells.

You have daily injections of growth factor for between 5 and 10 days. Sometimes you might have low doses of chemotherapy with the growth factor injections.

On the collection day

After your growth factor injections, you have blood tests every day to see if there are enough stem cells in your bloodstream. When there are enough cells, you have them collected. This is called harvesting. Collecting the stem cells takes 3 or 4 hours. You are awake during this process. You lie down on a couch. Your nurse puts a drip into each of your arms and attaches it to a machine.

Your blood passes out of one drip. It goes through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood. They are collected and frozen until after your high dose treatment.

You may need to go back the following day for a second harvest if they don't have enough cells from the first collection.

Side effects

You might feel very tired after having your stem cell collection.

You might have:

• tingling around your mouth
• muscle cramps

This happens if your calcium level gets low during your collection. Your nurses will give you extra calcium through a drip if this happens.

Having your bone marrow taken out

You have your bone marrow taken (bone marrow harvest) under a general anaesthetic. This means you are asleep and can't feel anything during the procedure.

You lie on your side on a couch. Your doctor puts a needle through your skin into the hip bone (pelvis). The doctor gently draws out the bone marrow through the needle into a syringe. To get enough bone marrow the doctor needs to put the needle into several parts of the pelvis. You have about 2 pints (1 litre) of bone marrow taken out and then it's frozen until it's needed.

Having stem cells or bone marrow from a donor

You might have a stem cell or bone marrow transplant using cells from a donor.  This is called an allogeneic transplant. The cells need to be as similar as possible to yours.

So these can be from:

• a brother or sister (a sibling match)
• someone not related to you but whose stem cells are similar to yours (matched unrelated donor)

You might have bone marrow from a donor if:

• your lymphoma has come back after a transplant using your own cells (autologous)
• your lymphoma is quite advanced and is in your bone marrow

Doctors are still learning how best to use allogeneic transplants for Hodgkin lymphoma.

Possible side effects

The side effects of having a stem cell or bone marrow transplant are caused by high dose chemotherapy.

The main side effects include:

• increased risk of getting an infection
• low blood cell counts
• increased risk of bleeding
• a reaction called graft versus host disease, the donor cells can sometimes attack some of your own body cells