See how you have high dose chemotherapy and whole body radiotherapy along with a stem cell or bone marrow transplant.
What it is
Stem cell and bone marrow transplants are a way of giving very high doses of chemotherapy. Sometimes you also have whole body radiotherapy (total body irradiation).
The high dose treatment kills off the cancer cells in the body but also kills the stem cells that make blood cells in the bone marrow. We need stem cells in order to survive.
So after the high dose treatment, you have stem cells or bone marrow through a drip into your bloodstream. These cells make their way into your bone marrow and start to make blood cells again.
These days it is more common to have a stem cell transplant than a bone marrow transplant.
But you might have a bone marrow transplant if collecting stem cells is difficult.
Having high dose chemotherapy
After your stem cell or bone marrow collection, you have high dose chemotherapy to kill any NHL cells that are left in your body. You might also have radiotherapy to your whole body.
You have your chemotherapy drugs through a tube put into a major vein in your chest (a central line). This means that you don't need to have any injections. You can also have other drugs through the tube, such as anti sickness drugs. And you can have blood taken from the line for blood tests.
You have high dose chemotherapy over about 5 or 6 days. This depends on which combination of drugs you have.
Having whole body radiotherapy
Depending on your particular treatment schedule, you might have radiotherapy to your whole body. You have treatment to your whole body to help kill off any remaining lymphoma cells left behind after chemotherapy. This is called whole body radiotherapy or total body irradiation (TBI).
You usually have TBI at the end of your chemotherapy treatment, just before the nurse gives you back your bone marrow or stem cells.
First you have a planning session of about 90 minutes to create the treatment plan. You lie on a hard couch or stand supported by a specially designed frame.
The radiographers measure the thickness of various parts of your body. They make sure the treatment couch or frame is in exactly the right position.
During this session you have a very small dose of radiotherapy aimed at your body from a machine next to the treatment couch or frame. Half your body is treated for 10 to 15 minutes. Then you turn and have the other half treated.
You might have TBI twice a day for 3 or 4 days, or as a single treatment. For these sessions the radiographers help you to lie or stand in the correct position. This can take up to half an hour. Then you have treatment for 10 to 15 minutes on both sides of your body.
Having your stem cells or bone marrow back
After you finish all your treatment, the nurse gives you back your stem cells or bone marrow.
You have stem cells and bone marrow back through a drip, just like a blood transfusion. They drip into your central line and into your bloodstream. They find their own way back into your bone marrow and start to grow again. Soon they start to make new blood cells for you.
Being in isolation
After high dose chemotherapy, you have low numbers of blood cells for some time. This means you are at risk of picking up infections.
You might have a single room in the hospital ward to help protect you from infection. You stay in the single room until your bone marrow has started to make blood cells again and your blood counts have come up. This can take a few weeks.
Some hospitals don't isolate patients having their own stem cells (autologous transplants). This is because the risk of infection is lower than after a bone marrow transplant. You usually stay in isolation in a single room if you are having donated marrow or stem cells (allogeneic transplant).
While you are in isolation you can have visitors, but your nurses may suggest that you only have one or two each day. Your friends and relatives should not come to see you if they are not well, or if they have been in contact with anyone with an infectious disease.
You need to wash often and keep very clean. You also need to follow a special diet including foods that are not likely to give you an infection.