High-dose treatment with stem cell support for Hodgkin lymphoma
Some patients need to have very high doses of chemotherapy, sometimes combined with radiotherapy. This is done if your doctors feel it will improve the chances of curing the Hodgkin lymphoma.
You may be given high-dose chemotherapy if standard chemotherapy has not completely got rid of the disease.
It may also be used if the lymphoma comes back after you’ve had standard chemotherapy. Your doctor will discuss with you whether or not high-dose treatment is necessary, and possible, in your case.
High doses of chemotherapy destroy the bone marrow where our blood cells are usually made. This means that before high-dose treatment can be given, stem cells (the basic blood cells from which other cells develop) must be collected from your body at a time when you are well. This is called a stem cell harvest.
Before the stem cells are collected you will usually be given chemotherapy followed by injections of substances called growth factors. Together, they stimulate the bone marrow to produce new stem cells and increase the number of stem cells in your blood. The stem cells are then collected by a process in which blood is removed through a needle in your arm. The blood is then passed through a machine called a cell separator. The stem cells are separated from the rest of your blood, which flows back into you through another needle.
Alternatively, stem cells can be collected from your bone marrow. For this, you will need to have a general anaesthetic.
The stem cells are then frozen and kept in storage until you have high-dose treatment.
After the high-dose chemotherapy has been given, the stem cells are thawed and given back to you through a drip to support your immune system. The stem cells make their way to your bone marrow where they start to produce blood cells. This can take a few weeks. You will be very prone to infection at this time and are likely to need to stay in hospital.
In most cases, your own stem cells are collected and then given back to you after the high-dose chemotherapy. This is called an autologous transplant.
Some people may be given stem cells from another person (a donor) rather than using their own cells. This is called an allogeneic transplant.
Stem cell and bone marrow transplants are complicated treatments and carry some risk. Because of this, they are generally carried out in specialist cancer treatment hospitals. This might mean you have to be treated in a hospital some distance from your home.
If you’ve had high-dose treatment with stem cell support and need a blood or platelet transfusion, you should receive blood or platelets that have been treated with radiation (irradiated). This lowers the risk of the donated blood cells reacting against your own blood cells. People who have had this treatment should carry a card or wear a bracelet/necklace sometimes called a Medicalert, so that hospital staff are aware of this in case of an emergency.
We have a section on stem cell and bone marrow transplants which gives more information on this treatment.