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Stem cell transplant is used to treat non-Hodgkin lymphoma (NHL) in certain situations. You might also hear it called a bone marrow transplant.

When is stem cell transplant used for NHL?

There are a few situations in which stem cell transplant is most often used:

• When lymphoma has relapsed.
• When lymphoma has not responded well to initial treatment.
• To help lower the chance of relapse in select high-risk lymphomas that have achieved remission.

The role of transplant continues to evolve as newer treatments such as CAR T-cell therapy become available.

Why are stem cell transplants used for NHL?

A stem cell transplant lets doctors give higher doses of chemotherapy (chemo), sometimes along with radiation therapy.

Standard doses of chemo may not always be enough to cure lymphoma. Higher doses might kill more cancer cells, but these high doses normally cannot be used because they severely damage your bone marrow, which is where most new blood cells are made.

But with a stem cell transplant, you can get high doses of chemo because you also get a transplant of blood-forming stem cells to restore your bone marrow after the chemo.

Types of stem cell transplant

There are 2 main types of stem cell transplant (SCT). Each type uses different sources of blood-forming stem cells.

• Autologous transplant: uses your own blood stem cells
• Allogeneic transplant: uses blood stem cells from a donor

Autologous transplant

Autologous transplant is the type of SCT used most often for lymphoma.

In this type of transplant, your own blood stem cells are used. Your stem cells are collected several times in the weeks before treatment. The cells are frozen and stored while you get high-dose chemo. After chemo, they are put back into your blood through a vein (IV).

Allogeneic transplant

Allogeneic transplant may be an option for some people with lymphoma.

This type of transplant uses blood stem cells from someone else (a donor). Blood stem cells for this type of transplant usually come from a brother or sister, but they can also come from an unrelated donor or from umbilical cord blood.

The donor’s tissue type (HLA type) needs to match your tissue type as closely as possible to help lower the risk of major problems with the transplant. The stem cells are frozen and stored until they are needed for the transplant.

Which type of transplant is used most often for lymphoma?

Autologous SCT (with your own stem cells) is used more often to treat lymphoma. But if the lymphoma has already spread to your bone marrow or blood, using your own stem cells might not be an option. It might be too hard to get stem cells that are free of lymphoma cells.

Allogeneic SCT (with donor stem cells) is used less often for lymphoma because it can have severe side effects.

• One of the most serious risks is graft-versus-host disease (GVHD).
• GVHD happens when the donor's immune cells see your body as foreign and attack it.
• GVHD can affect your skin, liver, and digestive tract. It can range from mild to life-threatening.

Medicines are also given to help prevent and treat GVHD. But this serious side effect is one of the main reasons allogeneic transplants are used carefully and only in select patients.

Reduced-intensity conditioning (RIC) transplant: To reduce the risk of GVHD, doctors might use a RIC transplant. This is sometimes called a mini transplant. It uses lower doses of chemo before the transplant, making it better tolerated for older people or people with other health problems. This option relies more on the donor immune cells to fight the lymphoma rather than on high-dose chemotherapy alone.

Deciding to get a stem cell transplant for NHL

A stem cell transplant is a complex treatment. It can cause life-threatening side effects.

If your cancer care team thinks you might benefit from a transplant, it’s important to discuss:

• What kind of transplant you’ll have
• The possible side effects
• How long it may take for you to recover

Stem cell transplants should be done at a cancer center where the staff has experience with the procedure and with managing the recovery phase.