Stem Cell Transplantation for Non-Hodgkin Lymphoma

High doses of chemotherapy can be an effective way to destroy lymphoma cells that have come back after conventional doses. However, high-dose chemotherapy can also destroy the healthy bone marrow cells that produce your blood and immune system cells. These bone marrow cells are also known as stem cells.

Stem cells develop into red blood cells, which provide oxygen to tissue; white blood cells, which fight infection; and platelets, which help with blood clotting. If stem cells are destroyed by chemotherapy, production of red cells, white cells, and platelets stops.

With stem cell transplantation, damaged bone marrow cells are replaced with healthy stem cells after you receive high-dose chemotherapy. This process preserves blood cell production while allowing doctors to treat the disease in the most effective way possible.

Our team at the Blood and Marrow Transplant Program, part of NYU Langone’s Perlmutter Cancer Center, specializes in autologous and allogeneic transplants, the two main types of transplantation used to treat non-Hodgkin lymphoma. These procedures are performed at the Rita J. and Stanley H. Kaplan Blood and Marrow Transplant and Cell Therapy Center.

Autologous stem cell transplantation uses stem cells collected from your own bloodstream. Before collection, doctors may give you medications that cause stem cells to leave the bone marrow and circulate in the blood.

Some blood is then removed from the body through a catheter, or hollow tube, connected to a machine that filters out the stem cells. The remaining parts of the blood are infused back into the body.

Collection takes several hours per day, over three to five days. Collected stem cells are frozen for later use.

After the stem cells are collected, high-dose chemotherapy with or without radiation therapy is given for several days. Radiation therapy is used to treat the whole body, and can help destroy cancer in places that chemotherapy may not easily reach. After this treatment, your own frozen stem cells are then thawed and transfused back into your body. The stem cells travel to the bone marrow, where they begin to make healthy new blood cells.

Many factors influence the decision to use autologous stem cell transplantation, including the lymphoma subtype and the response of the cancer to the initial therapy. In some forms of non-Hodgkin lymphoma, this transplant can result in a lasting remission, where signs and symptoms of the disease go away.

Allogeneic stem cell transplantation uses stem cells from a donor, usually a close blood relative or someone who is a genetic match with similar blood and tissue types. The goal is the same as with an autologous transplant: to repopulate the bone marrow with stem cells. These cells then develop into healthy white blood cells that can mount an immune response that destroys non-Hodgkin lymphoma cells in your body.

The first step in allogeneic transplantation is several days of high-dose chemotherapy, with or without radiation therapy, in the hospital. Doctors then transfuse the donor stem cells into the body with an intravenous catheter. The stem cells travel to the bone marrow, where, over time, they begin to make new blood cells that can create an immune response against the cancer cells.

This form of transplant can be quite effective with either slow-growing or more aggressive forms of non-Hodgkin lymphoma. But it carries more risk than autologous transplant: the donor stem cells may see your healthy cells as foreign, attacking them in a condition called graft-versus-host disease, or your body may see the donor stem cells as foreign, creating an unhealthy immune response. This complication can be prevented and managed during treatment with medications that suppress the immune system.

People undergoing either autologous or allogeneic stem cell transplantation are in the hospital for several weeks. During this time, our doctors carefully oversee your care.

Because high-dose chemotherapy with or without radiation therapy causes blood cell levels to decrease, most people require blood transfusions after transplantation. Transfusions may include red blood cells to treat anemia and its associated fatigue and platelets to prevent problems with clotting.

Because a stem cell transplant increases risk for infection—especially in those who are taking drugs to suppress the immune system for allogeneic transplantation—doctors usually prescribe antibiotics.

After 10 to 14 days, transplanted stem cells start to make healthy new blood cells. Once your doctors determine you are well enough, you can go home. Frequent follow-up appointments are needed because your immune system may be weak for three or four months. Sometimes, the recovery time for people who have undergone an allogeneic transplant may be longer because the immune system is more compromised.

NYU Langone offers several physical and psychological support services to help you and your family throughout the stem cell transplantation and recovery process.

NYU Langone conducts clinical trials investigating how stem cell transplants can be more effective and cause fewer side effects. Your doctor can help you to determine whether a traditional or more experimental approach to transplantation is best for you.