High-dose Chemotherapy and Stem Cell Transplant for Hodgkin Lymphoma

Stem cell transplants (SCTs) are sometimes used for hard-to-treat Hodgkin lymphoma , such as disease that doesn’t go away completely after chemotherapy (chemo) and/or radiation or lymphoma that comes back after treatment.

The doses of chemo drugs given to patients normally are limited by the side effects these drugs cause. Higher doses can’t be used, even if they might kill more cancer cells, because they would severely damage the bone marrow, where new blood cells are made.

A stem cell transplant lets doctors give higher doses of chemo (sometimes along with radiation therapy). This is because after getting high-dose chemo, the patient receives a transplant of blood-forming stem cells to rebuild the bone marrow.

The blood-forming stem cells used for a transplant can come either from the blood or from the bone marrow. Today, most transplants are done with cells that are taken out of the blood and are called peripheral stem cell transplants.

Types of transplants

There are 2 main types of stem cell transplants. They use different sources of blood-forming stem cells.

• In an autologous stem cell transplant, a patient’s own blood stem cells are collected several times in the weeks before treatment. The cells are frozen and stored while the person gets treatment (high-dose chemo and/or radiation) and then are given back into the patient’s blood by an IV. This is the most common type of transplant for Hodgkin lymphoma.
• In an allogeneic stem cell transplant, the blood stem cells come from someone else. Usually this is a brother or sister, but the source could be an unrelated donor or umbilical cord blood. The donor’s tissue type (also known as the HLA type) needs to match the patient’s tissue type as closely as possible to help prevent major problems with the transplant. Usually, in treating Hodgkin lymphoma, an allogeneic transplant is used only if an autologous transplant has already been tried without success.

A stem cell transplant is a complex treatment that can cause life-threatening side effects. If the doctors think a person might benefit from a transplant, it should be done at a cancer center where the staff has experience with the procedure and with managing the recovery phase.