Bone marrow transplant for lymphoma: Effectiveness and risk

A bone marrow transplant, or stem cell transplant, places blood stem cells back into the body. The transplant replaces cells that cancer or treatments have destroyed.A person may have a bone marrow transplant during or after cancer treatment.Bone marrow transplants mean doctors can use high dose chemotherapy and radiation to kill cancer cells.However, the high doses can cause severe damage to the bone marrow, including healthy cells. A bone marrow transplant can help replace these cells.There are two types of bone marrow transplants for lymphoma, depending on where the cells come from:Autologous transplant: The stem cells come from the person receiving the transplant.Allogeneic transplant: The stem cells come from a matched donor.For both types, doctors collect the stem cells, freeze them, then thaw and deliver them into the body after cancer treatment.To remove stem cells from the bone marrow, a doctor may first administer a general anesthetic to minimize discomfort.A surgeon usually removes bone marrow from the pelvic bones with a large needle. The body generally replaces the removed cells in a few weeks.The extraction procedure may take 1 to 2 hours. A person may experience soreness in the pelvic area for a few days after the procedure, but pain medication can help manage this.A laboratory then removes the stem cells from the bone marrow, freezes them, and stores them until the transplant.Doctors collect stem cells from a person’s own body several times, a few weeks before the start of cancer treatment.The person receives high dose chemotherapy, radiation therapy, or both to kill cancer cells.After the high dose cancer treatments, a doctor returns the collected stem cells to the person’s body through an intravenous catheter. This replenishes healthy cells that were damaged during treatment.In an allogeneic transplant, the process is similar, but the stem cells come from a donor rather than the person receiving the transplant.Another type of stem cell transplant a doctor may consider is a peripheral blood stem cell transplant. In this procedure, stem cells are collected from the blood rather than directly from the bone marrow with a needle and transplanted.According to a 2018 review, autologous transplants are the standard treatment for young, otherwise healthy people with Hodgkin’s lymphoma if initial treatments have been ineffective. The transplants may be effective in almost 50% of cases.A complete response to transplant, which means tests or scans do not show signs of cancer, may lead to a more favorable outlook.Follow-up cancer treatments, such as drug therapies, after an autologous transplant may help increase rates of complete remission and improve outcomes.In some cases, a bone marrow transplant may cure non-Hodgkin’s lymphoma.According to a 2018 review article, allogeneic stem cell transplant may lead to long-term remission in around 30% to 50% of people with relapsed and refractory T-cell lymphoma, which is a type of non-Hodgkin’s lymphoma.Possible risks of autologous transplants include the transplanted stem cells not working as they should and failing to make replacement blood cells.The collection of stem cells may also inadvertently include cancer cells, which can return to the body with the transplant.Possible risks of allogeneic transplants include:the donor stem cells may not survive, or the body may destroy the transplanted cells before they can workinfections from the donor cells, although this risk is low because donors undergo testing for infectious diseases before donating cellsa previous infection may reactivate due to a weakened immune system from immunosuppressive drugs, which help the body accept the donor cellsgraft-versus-host disease, in which immune cells in the donor cells attack healthy cells within the body of the person receiving the transplant, and can be mild to severeGraft-versus-host disease (GVHD)People should let a doctor know if they have any side effects after a transplant. They will need to contact a doctor immediately if they have symptoms of GVHD, including:can safely receive high dose chemotherapy and radiationhave tumors that are responsive to drugshave relapsed, aggressive lymphoma that still responds to chemotherapyDoctors will also consider other factors, such as:ageoverall healthmedical historystage of lymphomaresponse to previous treatmentTo find a donor, doctors may start with any siblings or close relatives. To determine a match, doctors look at human leukocyte antigen (HLA) proteins on the surface of cells. If no close relatives match, doctors will look at transplant registries of volunteer donors.A person may have a bone marrow transplant for lymphoma to replace stem cells after high dose chemotherapy or radiation. A bone marrow transplant can also be done if lymphoma is in remission or has relapsed after treatment.For some people, a bone marrow transplant may help improve their overall outlook. However, some people may experience complications or side effects, such as infections or graft-versus-host disease.An individual can speak with their healthcare team about bone marrow transplants if they have lymphoma to see whether it is a suitable option for them.



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