Stem cell transplant for Hodgkin lymphoma

A stem cell transplant replaces stem cells. It uses chemotherapy at very high doses to kill all of the cells in the bone marrow. This includes both healthy cells and cancer cells. Sometimes total body irradiation (also called whole body radiation therapy) is also used. After high-dose chemotherapy, healthy stem cells are given to replace the ones in the bone marrow that were killed.

Stem cells are found in bone marrow, blood and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells.

Some people with Hodgkin lymphoma (HL) will have a stem cell transplant. It can be used to treat HL that comes back (relapses or recurs) after treatment or HL that doesn’t respond (is refractory) to other treatments.

A stem cell transplant is very risky and complex, and it must be done in a special transplant centre or hospital. Your healthcare team will consider offering a stem cell transplant only if you are younger than 60 and are in good health overall.

The following types of stem cell transplant may be used for Hodgkin lymphoma.

In this type of transplant, the stem cells are taken from your own bone marrow or blood.

An autologous transplant is the type used most often for HL. But it may not be possible to do it if HL has spread to the bone marrow and your healthcare team can’t remove enough healthy stem cells for the transplant.

In this type of transplant, the stem cells are taken from one person (the donor) and are given to another person (the recipient). The donor and the recipient may or may not be related. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.

Your healthcare team may offer an allogeneic transplant for HL that has come back after an autologous stem cell transplant. It may also be offered if your healthcare team can't remove enough of your own healthy stem cells for an autologous transplant.

Consolidation therapy is given after chemotherapy used for the stem cell transplant is finished. The goal of consolidation therapy is to destroy any disease that remains in the body.

The targeted therapy drug brentuximab vedotin (Adcetris) may be used as consolidation therapy after a stem cell transplant for HL if:

• the HL was refractory to earlier treatments
• the HL came back within 12 months after finishing earlier treatments
• the HL was outside of the lymphatic system (called extranodal sites) when it came back (relapsed or recurred)

Side effects of a stem cell transplant will depend mainly on the type of chemotherapy or drug combination given, if radiation therapy was given, the type of transplant and your overall health. Tell your healthcare team if you have side effects that you think are from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Side effects of a stem cell transplant include:

• low blood cell counts
• fatigue
• sore mouth and throat
• nausea and vomiting
• lung problems
• kidney problems
• heart problems
• fertility problems
• hair loss
• loss of appetite
• weight loss
• graft-versus-host disease (GVHD) with allogeneic transplant

Find out more about a stem cell transplant and side effects of a stem cell transplant. To make the decisions that are right for you, ask your healthcare team questions about a stem cell transplant.