High-dose treatment with stem cell support for Hodgkin lymphoma

Stem cells are early blood cells. They make all the other types of blood cells you need. High doses of chemotherapy can destroy lymphoma cells, but also the bone marrow – where new stem cells are made.

If you need high doses of chemotherapy, a stem cell transplant can help your body cope with the effects of treatment. This may be necessary if your lymphoma comes back (recurrence), or doesn’t respond well to standard chemotherapy.

Before receiving high-dose treatment, stem cells are collected from your body and stored. After your course of chemotherapy, these will be thawed and put back using a drip. This helps your bone marrow recover and start making new blood cells again. Some people may be given stem cells from another person (a donor).

This treatment is intensive and complicated – you will need to attend a specialist hospital. It’s usually only given to people who are fit enough to cope with side effects. Your doctor will discuss with you whether or not a stem cell transplant is suitable.

High dose chemotherapy for Hodgkin lymphoma

Some people need to have very high doses of chemotherapy, sometimes combined with radiotherapy. Your doctors may suggest this treatment if they feel it will improve the chances of curing the disease or achieving long term remission. Remission means that the Hodgkin lymphoma is well controlled and can’t be detected through tests or scans.

They may also suggest high-dose chemotherapy if standard chemotherapy has not completely got rid of your disease or it may also be used if the lymphoma comes back. Before you have high-dose treatment you will be given further chemotherapy to help control the Hodgkin lymphoma. Your doctor will discuss with you whether or not high-dose treatment is necessary, and possible, in your case.

Stem cell collection

Stem cells are found inside our bone marrow. They make all the red blood cells, white blood cells and platelets in the blood. High doses of chemotherapy destroy the bone marrow where the stem cells are made. So before high-dose treatment can be given, stem cells must be collected from your body at a time when you’re well.

Before the stem cells are collected you will usually be given chemotherapy followed by injections of substances called growth factors. These stimulate the bone marrow to produce new stem cells and increase the number of stem cells in your blood. You’ll then have your stem cells collected.

Usually, the stem cells are collected by removing your blood through a needle in your arm. The blood is then passed through a machine called a cell separator which separates the stem cells from the rest of your blood. Your blood then flows back into you through another needle.

Alternatively, your stem cells can be collected from your bone marrow. For this, you will need to have a general anaesthetic.

The collected stem cells are frozen and kept in storage until you have high-dose treatment.

Stem cell transplant

You will have the high-dose chemotherapy over a few days. The stem cells are thawed and given back to you through a drip after the chemotherapy. The stem cells make their way to your bone marrow where they start to produce blood cells. This may take a few weeks.

You will need to stay in hospital during the treatment as you will be prone to infection throughout this time.

The most common type of transplant used to treat Hodgkin lymphoma is called an autologous transplant. This is when your own stem cells are collected and then given back to you after the high-dose chemotherapy. Less commonly, you can be given stem cells from someone else (a donor). This is called an allogenic transplant.

We have a section on stem cell and bone marrow transplants which gives more information on this treatment.