High-dose treatment with stem cell support

For some patients, even though they have been treated for non-Hodgkin’s lymphoma, there is still a high risk of the cancer coming back. Others may need more treatment as initial treatment has failed. High-dose chemotherapy may be given. Because this treatment would destroy the bone marrow that produces the blood cells that are essential for good health, bone marrow needs to be removed and then replaced after treatment is given. This can be achieved by collecting the patients own cells from the bone marrow or blood circulation before treatment begins and giving these cells back to the patient after treatment.

Autologous Bone Marrow Transplant (ABMT)

If the cells are taken from your own bone marrow this is called an Autologous Bone Marrow Transplant (ABMT). The bone marrow is usually taken from your hip. A general anaesthetic is given before the procedure. You will not be allowed anything to eat or drink for several hours before the anaesthetic. You may be given a sedative before going to theatre. This will help you feel more relaxed.

When you are asleep a thin needle is passed through the skin into the hip-bone. The bone marrow is then drawn up through the needle into a syringe and stored until required. It is usually necessary to take bone marrow from different places in both hips to make up the amount needed. The procedure takes about 30-40 minutes to complete.

You will not be allowed to eat or drink anything for at least four hours after coming back from theatre. Your hips may feel tender and sore for a few days after the procedure. Ask your nurse for painkillers if you need them.

After your high dose treatment, the bone marrow is returned by intravenous infusion (drip). The bone marrow can be infused through a central line or other types of venous access. It will take your bone marrow about four weeks to recover and resume its role of fighting infection. However, it may take 6-12 months before you are fully recovered from the effects of high-dose chemotherapy. You may need to stay in hospital for several weeks due to infection or other effects of treatment.

Peripheral Blood Stem Cell Transplantation (PBSCT)

The cells can also be obtained from the bloodstream. These cells, normally found in the bone marrow, are called stem cells and are the basic cells from which all other blood cells grow. Before these stem cells can be collected from the bloodstream they must be moved out of the bone marrow. This occurs when the bone marrow is stimulated to produce a lot of stem cells. The bone marrow gets overcrowded and the extra stem cells spill over into the bloodstream. To make this happen your doctor will give you chemotherapy and/or a special drug called a growth factor. The stem cells are then collected from the bloodstream. This procedure is called Peripheral Blood Stem Cell Transplantation (PBSCT).

The chemotherapy is usually given over a couple of days. The growth factor needs to be given daily for 10-14 days as a small injection under the skin. You can either do this yourself or your doctor or nurse can do it for you. About day 10 of the injections, when your blood is ready, the stem cells can be collected. This takes about 3-4 hours each day for 2 or 3 days. It some cases it is possible to collect all the stem cells required in one day.

The stem cells are collected from a central venous line or from intravenous lines placed in large veins in your arms. Blood is taken out through the drip into a machine that separates the stem cells from the rest of your blood. This is called a leukopheresis machine. The stem cells are collected into a bag and the rest of the blood is returned to you.

The stem cells are frozen until you have had the high-dose chemotherapy. Then they are thawed out and returned to you through a drip or central venous line. These stem cells will help your bone marrow recover from the effects of treatment. This normally takes about two weeks. However, it may take 6-12 months before you are fully recovered from the effects of high-dose chemotherapy. You may need to stay in hospital for several weeks due to infection or other effects of treatment.

Before consenting to either of the above treatments make sure you understand why you should have it and what are its chances of success. You will also need to know about the side effects of such treatment and how long they will last. Talk to your doctor or nurse. Ask them to go over the procedure with you in detail. Write down your questions if necessary.

There is a support available for you at this time and throughout treatment. In Ireland, call the Cancer Helpline Freefone 1800 200 700 for more information.