Stem Cell Transplantation for Hodgkin Lymphoma

If Hodgkin lymphoma does not enter remission or if lymphoma returns after chemotherapy or radiation therapy, doctors at the Blood and Marrow Transplant Program, part of NYU Langone’s Perlmutter Cancer Center, may recommend a stem cell transplant. This procedure is performed at the Rita J. and Stanley H. Kaplan Blood and Marrow Transplant and Cell Therapy Center.

Stem cells develop into specialized cells with specific functions in the body. A stem cell transplant can help your body produce enough white blood cells, which fight infection; red blood cells, which bring oxygen to tissue; and platelets, which help blood clot.

In an autologous stem cell transplant, NYU Langone doctors collect stem cells from your own blood. During this procedure, your doctor may give you medications that cause stem cells to leave the bone marrow and circulate in the blood, where they are easier to collect. He or she uses a catheter, a thin, hollow tube, to remove blood from the body. The blood is sent to a machine for filtering and infused back into the body.

Collecting these cells takes several hours per day for three to five days. The stem cells are placed in frozen storage for use during the transplant.

Next, doctors prescribe high-dose chemotherapy—with or without radiation therapy—for several days to kill cancer cells. Frozen, healthy stem cells are thawed and transfused into the body, where they return to the bone marrow. There, they start to make healthy blood cells.

This type of stem cell transplant is more common in adults, not children, with Hodgkin lymphoma.

Less frequently, stem cells are retrieved from a healthy donor and infused into your body. This is called an allogeneic stem cell transplant. The donor must be a “match,” meaning the person’s genetic makeup and tissue types are compatible with yours. Blood tests are performed to determine if a donor is a good match. Siblings are often ideal, but other relatives can be matches, too.

Donors who are not related to you may be found through national bone marrow registries. NYU Langone staff can help you find a donor match. It can take some time to find a suitable donor or donors and perform the necessary testing. If it takes longer than expected, your doctor may recommend an additional cycle of chemotherapy to prevent cancer cells from growing until the search is complete.

Recovery From Stem Cell Transplantation

After a stem cell transplant, you remain in the hospital in isolation for up to four weeks to protect you from infection. Your doctor may give antibiotics through a vein with intravenous (IV) infusion to prevent or treat any infections. You may need red blood cell and platelet transfusions until the healthy stem cells start dividing and multiplying in your body.

Once your doctors determine you are well enough, you can go home. Because your immune system may be weak for three or four months, frequent follow-up appointments are necessary. Allogeneic stem cell transplants may require longer recovery times because the donor cells can cause graft-versus-host disease, which occurs when donor cells attack healthy tissues in your body. Full recovery can take several months.

Long-term side effects of stem cell transplantation may include infertility, because certain chemotherapy drugs can reduce sperm levels in men and damage ovaries, induce menopause, and reduce hormone levels necessary for pregnancy in women. You and your doctor can discuss banking eggs or sperm for later use prior to treatment, and he or she can refer you to specialists at NYU Langone’s Fertility Center or NYU Langone Reproductive Specialists of New York.

After a stem cell transplant, some people experience neutropenia, in which levels of white blood cells remain low, increasing your risk of infection. NYU Langone doctors monitor your blood cell levels and prescribe a white blood cell-boosting medication, if necessary.