Can Lymphoma Be Treated With Stem Cell Transplant? What Patients Should Know

Receiving a diagnosis of lymphoma can be overwhelming. When a loved one faces such a diagnosis, experiencing confusion and anxiety about what comes next is an expected reaction. Amid explanations about chemotherapy and radiation, targeted therapy and immunotherapy, the healthcare provider may suggest another critical treatment option – stem cell transplant for lymphoma treatment. You can better understand this significant phrase by learning a bit more about what happens before, during and after.

Lymphoma and Stem Cells: An Introduction

Lymphoma is a cancer of the body’s immune system. The cancer of the lymphocytes, or white blood cells, can be of two types:

• Hodgkin Lymphoma (HL): This cancer starts in the lymphatic system and triggers the growth of abnormal cells known as Reed-Sternberg cells.

• Non-Hodgkin Lymphoma (NHL): This cancer starts when lymphocytes grow aggressively and form tumours.

A newborn’s umbilical cord blood abounds in stem cells. These undeveloped cells can seamlessly go on to develop into:

• Red blood cells: essential for delivering oxygen around the human body
• White blood cells: responsible for fighting off infection
• Platelets: help in blood clotting that stops unnecessary bleeding

Once a lymphoma establishes and spreads, the “standard” use of chemotherapy or radiotherapy may not remove all the cancerous cells. However, administering very high doses of these treatments can also severely damage the body’s healthy blood-forming cells. A stem cell transplant for such cancers can enable use of intensive treatment while providing healthy blood-forming stem cells to help restore the blood and immune systems afterwards.

What Circumstances Warrant Stem Cell Transplant?

Medical practitioners worldwide follow general guidelines when considering stem cell transplant for lymphoma. The following specific situations call for this mode of treatment:

• Relapsed Therapy: This is when the cancer returns after a period of improvement. The remaining cells are often resistant to initial treatments, requiring second-line or advanced approaches.

• Refractory Therapy: In these cases, the cancer does not respond to front-line treatment or only mildly improves and is likely to progress.

• Aggressive Lymphoma: Certain kinds of non-Hodgkin lymphoma with specific high-risk features make recurrence likely. Doctors perform a transplant as consolidation therapy while in first remission.

Doctors also consider factors such as the type of lymphoma, the patient’s age, overall health and how well their heart and lungs are functioning before deciding whether to start with the lymphoma transplant treatment.

Types of Stem Cell Transplants for Lymphoma

There are two major types of stem cell transplants that doctors may use to treat lymphoma.

Autologous Stem Cell Transplant

This procedure acts as a rescue after high-dose therapy, clearing resistant disease. The standard treatment for relapsed Hodgkin and aggressive Non-Hodgkin lymphomas.

There is no risk of transplant rejection or GvHD. Autologous transplant is now the standard procedure for almost all Hodgkin Lymphomas, and many relapsed diffuse large B-cell Lymphomas (DLBL) that are deemed to be responsive to second-line chemotherapy regimens.

Allogeneic Stem Cell Transplant

This procedure uses umbilical cord blood stem cells from a perfectly matched immediate family member, including a sibling or a matched unrelated donor, to replace the patient’s immune system.

The biological benefit of allogeneic stem cell therapy for lymphoma is the Graft-versus-Lymphoma GVL effect. This means the immune system can replace the missing lymphocytes. The donor’s stem cells can also recognise and attack cancer cells, helping to remove them from the body.

Understanding the Transplant Process

Thinking of the upcoming transplant in a sequence of easy-to-manage steps can make this a far less overwhelming process.

Step 1: The Pre-transplant preparation

The transplant team perform a series of tests before determining whether the patient can endure the transplant. The PET/CT scans help doctors determine how well the disease is responding to treatment. Blood tests and heart scans check your overall health and heart function. Lung tests assess how well your lungs are working, while a dental check-up helps reduce the risk of infection.

Step 2: Obtaining Stem Cells

This is where the cryogenically frozen umbilical cord blood stem cells come to the rescue. The newborn’s umbilical cord blood stem cells are preserved in a private cord blood bank, a safety net for the entire family, including those with a medical history of cancers, other blood disorders, Immune deficiency and metabolic disorders. Allogeneic patients receive lymphoma treatment with a stem cell transplant from a matched sibling or matched donor.

Step 3: The Conditioning Regimen

The patient will be moved to a specialist transplant unit where they receive massive doses of chemotherapy. In some cases, this may also include total body irradiation (TBI). The purpose is to kill remaining lymphoma cells and make room in the bone marrow for new stem cells to settle and start working.

Step 4: Day zero- the Infusion

In the transplant community, infusion day is known as “day zero”, the new biological birthday.

The stem cell infusion itself is harmless. The stem cells are thawed and given through your central venous catheter, much like a blood transfusion. The medical team closely monitors short-term side effects related to the storage solution, which may include an itchy throat and a garlic-like taste.

Step 5: Nadir and Engraftment

In the few weeks following “day zero, the patient faces very low blood cell counts and feels exhausted and susceptible to infections.

Gradually, the transplanted stem cells find the right niche and differentiate into new blood cells. Once neutrophil and platelet counts recover, engraftment takes place.

Controlling Side Effects and Risks

The stem cell transplant for non-Hodgkin or Hodgkin lymphoma can be rough on the body, but side effects can be managed through modern medical care.

Infections

The low white cell count is a crucial clinical concern. Patients stay in rooms with HEPA-filtered air, protected by food safety standards, and receive prophylactic antibiotics, antifungals, and antivirals.

Mucositis

Conditioning treatment can damage the lining of the mouth and cause painful mouth sores. Special mouth rinses and ice chips can help soothe the mouth during chemo treatment.

Graft-vs-Host Disease

In an allogeneic transplant, donor T-cells identify host organs such as the stomach, GI tract, and skin as non-self, either acutely or chronically. This is called GvHD, and can be controlled with appropriate immunosuppressive agents.

Conclusion

It is now established that lymphoma stem cell transplant treatment remains a potential treatment modality for relapsed or high-risk lymphomas. Taking one step at a time in each phase of the healing process allows thousands to live full and meaningful lives!