Lymphoma

High dose therapy and stem cell transplantation

Higher than normal doses of chemotherapy (and sometimes radiotherapy) are often used to treat people whose lymphoma has relapsed or has not responded adequately to other treatments. While chemotherapy at normal doses causes transient damage to the bone marrow, which makes blood cells (see 'Blood cell counts and infection risk'), high dose therapy suppresses the bone marrow for longer, and it then needs help to recover. This is achieved by transplanting (or grafting) stem cells (primitive cells that can develop into all the different types of cells in the body), which can repopulate the bone marrow.

The transplanted cells are most commonly the patient's own (an autologous transplant) or taken from a donor, either a close relative or an unrelated donor who is a close genetic match (an allogenic transplant). Cells for transplantation used to be taken directly from the bone marrow by inserting a needle into the hip bone under anaesthetic, but nowadays stem cells are usually 'harvested' from the blood using a cell separator machine. A man who had a transplant long ago had cells taken from his bone marrow, and another had this done in case the harvesting did not work. 

Before harvesting, the number of stem cells in the blood is boosted by a series of daily injections of Granulocyte Colony Stimulating Factor (G-CSF) for between 5 and 10 days. Many people were taught to inject themselves; one was given them by a friend who was a nurse. During the procedure a machine takes blood from the arm, removes the stem cells, then gives the blood back through the other arm. This is repeated until enough cells are collected, which may take several hours over a few days. The cells are then frozen.

Some people said the G-CSF injections made their bones ache and one man experienced a pumping feeling in his body. The prospect of being connected to the machine could be scary, though the experience itself was not particularly unpleasant. Producing enough stem cells was sometimes a problem and one woman's transplant was abandoned for this reason. Although most people had their stem cells harvested for an immediate, planned transplant, a few had theirs harvested when they were in remission in case their disease relapsed in future.

Brothers or sisters were sometimes asked whether they would be tested to see if their stem cells would provide a suitable match for an allogenic transplant and, if so, they also had a series of G-CSF injections and their stem cells harvested on the cell separator machine. One man said the experience brought him and his sister closer together for a while. The sisters of a woman whose stem cells were harvested for a possible future transplant were also tested. One was a perfect match so she now has the option of an auto- or an allogenic transplant.

High dose chemotherapy is given daily for about a week in hospital and one man also had whole body radiotherapy. High dose chemotherapy is given in the same way as normal chemotherapy, often through a central line, and produces the same side effects. After the chemotherapy the frozen stem cells are thawed and given back via a drip. Some people said that although this was a vital part of the treatment it seemed insignificant as it was just another drip. Two people had reduced intensity transplantation, which involved being given a lower level of chemotherapy before receiving their donor's stem cells. This was an experimental treatment at the time they had it but is now standard. 

After the transplant people had to stay in hospital for three or more weeks while their blood cells recovered to normal levels, during which time they were very vulnerable to infection and some needed transfusions of red blood cells and platelets. Many people had their own room in hospital equipped with filtration equipment to clean the air to reduce the risk of infection. Some had private bathrooms, but others had to share toilets with other patients and visitors. Staff and visitors were expected to wash their hands before entering the room; one man said his visitors had to wear an apron.

People often had to travel to a specialist hospital for their stem cell transplant, so some were too far away for friends and family to visit easily. Those with children said it was tough being separated from them for so long, especially if they stayed away to avoid passing on colds. People sometimes felt too ill to see visitors, which could cause tensions between family members. One man's wife stayed in a flat at the hospital throughout his treatment.

For the first week or so after treatment most people felt very ill and some didn't feel like eating and became very weak. One woman said she only felt like drinking milk or fruit juice and kept these in a mini-fridge in her room. A man said the hospital dietitian struggled to find appealing food that would build him up. As people began to feel better they watched television or read or went for short walks. Some got up and showered every day, one man said he managed to do some work and another ordered a new car. The extended hospital stay could be boring or depressing and people were often delighted to be allowed home.

Some people were still very weak after leaving hospital, found everyday tasks a big effort, and were dismayed by how long it took to recover. One man spent a couple of nights in the hospital flat where his wife was staying to see if he could cope with life outside hospital before going home. A woman told us that she needed walking sticks and other gadgets to help her around the home and a friend recommended some rehabilitation exercises. 

Last reviewed February 2016.

Last updated February 2016.

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