High dose chemotherapy destroys the lymphoma cells, but also damages the stem cells that make blood cells in the bone marrow. So if you have high dose treatment, you need a way of replacing (transplanting) the stem cells that have been destroyed.
This page is about having high dose treatment and an infusion of stem cells. For information about:
- what is a transplant
- types of transplant
- collection of stem cells
- side effects
Your doctor might recommend that you have lower doses of chemotherapy as part of your transplant. And you may not have radiotherapy. This is called reduced intensity treatment and is part of a mini transplant (reduced intensity transplant).
A mini transplant can be used for older people and those who are not fit and well enough to have high dose treatment. It means that you should have less severe side effects. People do not generally become as unwell, compared to high dose chemotherapy.
High doses of chemotherapy aim to kill all the stem cells in your bone marrow. The lower dose chemotherapy aims to reduce the number of stem cells in your bone marrow.
Doctors are still trying to work out when it is best for a person to have a mini transplant. And which type of NHL this is best suited for. You might have a mini transplant as part of a clinical trial.
Having high dose treatment
Before your transplant you have high dose chemotherapy. Some people also have radiotherapy. These treatments aim to kill any NHL cells that are left in your body.
You have your chemotherapy drugs through a tube put into a major vein in your chest (a central line). The drugs then go into your bloodstream. You can also have other drugs through your central line. For example, anti sickness medicines and antibiotics. And you can have blood taken from the line for blood tests.
You usually have high dose chemotherapy for about 5 or 6 days.
Total body irradiation (TBI)
Depending on your treatment schedule you might have radiotherapy to your whole body. This is called total body irradiation (TBI). You have TBI to help kill any lymphoma cells left behind after chemotherapy.
You usually have radiotherapy after chemotherapy, just before your stem cell or bone marrow transplant.
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.
Your treatment sessions
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 the stem cells
After you finish high dose treatment you have the stem cells. You either have your own stem cells back (an autologous transplant). Or stem cells from your matched donor (allogeneic transplant). You have the stem cells through a drip into your central line.
The stem cells move through your bloodstream and back into your bone marrow. This helps the bone marrow make healthy blood cells again. You have regular blood tests to check when your bone marrow starts to make new blood cells.
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 who have their own stem cells. This is because the risk of infection is relatively low. But patients who have donor stem cells will often have their own room, because the risk of infection is higher.
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 might need to follow a special diet including foods that are unlikely to give you an infection.
Some people become outpatients straight after their stem cell transplant. You need to attend the hospital daily for blood tests and treatment. But you only have to stay in hospital if you develop complications. Outpatient transplant treatment is becoming more common.
Coping with isolation
Staying in a single room in hospital can feel lonely. Some people find it frightening. It can help to talk to the nurses about your worries. They can reassure you.
Taking in some of your personal things can make the room feel more homely. Books and photos can brighten it up. You can also take in a laptop, tablet, mobile and music. This can help the time to pass and you can keep in touch with friends and family.
Possible side effects of transplants
The side effects of having a stem cell transplant are caused by high dose treatment and radiotherapy. These treatments lower the number of the different blood cells. Side effects include:
- increased risk of getting an infection
- tiredness and lacking energy
- increased risk of bleeding
- sickness and diarrhoea
Stem cells from a donor (allogeneic transplant) can cause a reaction called graft versus host disease (GvHD). This happens if the donor's stem cells attack some of your own cells.
Taking part in a clinical trial helps researchers improve treatments for NHL.