Stem cell transplant for Hodgkin lymphoma

You might have a stem cell transplant if your Hodgkin lymphoma has come back after treatment. This is sometimes called relapsed Hodgkin lymphoma.

A stem cell transplant allows you to have high doses of chemotherapy. The chemotherapy kills the Hodgkin lymphoma cells. But it also damages the normal stem cells.

When you have a stem cell transplant, you are given new stem cells. These stem cells go to the bone marrow and your body can start making blood cells again as your bone marrow slowly recovers.

What are stem cells?

Stem cells are very early cells made in the bone marrow. The bone marrow is a spongy material that fills the bones.

These stem cells develop into 3 different types of blood cells. They are:

• red blood cells - contain haemoglobin and carry oxygen around the body
• white blood cells - part of your immune system and help fight infections
• platelets - help clot the blood and stop bleeding

Why you might have a stem cell transplant

The first treatment for Hodgkin lymphoma is usually chemotherapy and radiotherapy.

You might have a stem cell transplant if one of the following happens:

• your first treatment doesn’t work as well as your doctor hopes

• your lymphoma comes back (relapses)

If your lymphoma comes back, or treatment isn’t working so well, you usually have further treatment to get your disease under control. If this happens, your doctor might then recommend you have a stem cell transplant.

The aim of the transplant is to cure your Hodgkin lymphoma.

Some people are not able to have a stem cell transplant. Your doctor will discuss other treatment options with you.

Types of stem cell transplant

For Hodgkin lymphoma, you usually have a transplant using cells collected from your own bloodstream or bone marrow. This is called an autologous transplant.

Autologous transplant

You usually have an autologous transplant using stem cells collected from your bloodstream. This is called a peripheral blood stem cell transplant (PBSCT). But you may have a transplant using stem cells collected from your bone marrow. This is called a bone marrow transplant.

PBSCT is more common than bone marrow transplants. This is because:

• it's easier to collect stem cells from the bloodstream than the bone marrow

• your treatment team can usually collect more cells

• your blood cell levels usually recover faster

Allogeneic transplant

You may have a stem cell transplant using stem cells from another person. This is called an allogeneic transplant. 

You might have an allogeneic transplant if you have had an autologous transplant first that hasn’t worked as well as your doctor would like.

Having a stem cell transplant

There are different stages of an autologous transplant.

Preparation

To prepare for your transplant, you have:

• various tests
• a central line put in

Central line

A central line is a long plastic tube that goes into a large vein near the heart. They can be used for taking blood samples and giving drugs.

Fertility

Your treatment could mean that you are unable to have children in the future. Talk to your healthcare team if this is a concern for you.

Growth factors

You have injections of growth factors before and after a stem cell transplant. Growth factors are natural proteins that help the bone marrow to grow cells. You have them as small injections under the skin.

Depending on your situation, you have daily injections of growth factor for between 5 and 10 days. Sometimes you might have low doses of chemotherapy alongside the growth factor injections.

Side effects of growth factor injections

You might have:

• itching around the injection site

• high temperature (fever)

• pain in your bones after you have had a few injections. This is because there are a lot of blood cells made inside the bones

Collection of your stem cells

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 between 3 to 4 hours. You are awake and need to sit or lie down and keep your arm still during this process. Your nurse puts a drip into each of your arms and attaches it to a cell separator 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. Your stem cells are collected, frozen and stored.

Side effects of collection of stem cells

Having stem cells collected can make you feel very tired.

Your calcium might also get low during your collection. You might have:

• tingling around your mouth

• muscle cramps

Your nurses will give you extra calcium through a drip if this happens.

Conditioning treatment

You usually have high dose chemotherapy after your stem cell collection. This is called conditioning treatment.

Your medical team will explain which drugs you are going to have and the possible side effects. This is usually a combination of chemotherapy drugs called BEAM or LEAM.

You usually have conditioning treatment a week before a stem cell transplant. You might stay in hospital whilst you have it. Or you might stay at home and go to the hospital every day for treatment and tests.

You have your stem cells back

After conditioning treatment, you have your stem cells back. You have these through your central line into your bloodstream.

Blood count recovery

The stem cells find their way back into your bone marrow where they make the blood cells you need. This recovery of blood cells is called engraftment.

You have regular blood tests to check when your bone marrow starts to make new blood cells. The time it takes for the new blood cells to appear (and blood counts to recover) can vary. This may take a few weeks, although it can vary from person to person.

During this time, you continue to have treatment for any side effects and symptoms. This might include:

• antibiotics and antiviral medicines to treat and prevent infection

• platelet transfusions if the number of platelets in your blood are low

• blood transfusions if your red blood cells are low

• medicines to relieve a sore mouth, diarrhoea and sickness

You may stay in hospital until your blood cells have recovered enough to go home. And you no longer have any severe side effects.

Some people can go home straight after their stem cell transplant. This is more likely if you have an autologous stem cell transplant. You need to attend the hospital daily for blood tests and treatment. You only stay in hospital if you develop complications.

Outpatient transplant treatment is becoming more common.

Possible side effects

The possible side effects of having a stem cell transplant are usually caused by high dose chemotherapy. This is because the treatment lowers the number of your blood cells. Side effects include:

• increased risk of getting an infection

• tiredness and lacking energy

• increased risk of bleeding

• sickness

• loose or watery poo (diarrhoea)

• feeling and being sick

• sore mouth and difficulty swallowing

You can have a reaction called graft verses host disease if you have an allogeneic stem cell transplant. This is when the donor cells attack some of your own body cells.