Stem cell transplants may be autologous, which means the stem cells come from your own body. Or they may be allogeneic, which means the stem cells come from a donor. Discuss the risks and benefits of each approach with your doctor beforehand. Here’s a general description of how a stem cell transplant is done.
You or your donor may get an injection of a growth factor drug for several days. This drug helps stimulate stem-cell production. Then a small tube, called a catheter, is used to take blood from your vein or that of the donor. This is similar to donating blood, but it takes several hours. The blood goes to a cell separation device to remove the stem cells. Then the extra blood is returned to you or the donor. This process, called apheresis, may need to be repeated more than once.
Another option is for the doctor to remove stem cells from either your bone marrow or that of your donor. The person whose cells are being removed — you or the donor — gets general anesthesia to put him or her to sleep. A doctor makes several punctures in the pelvic or hip bone to remove marrow. Soreness in the hip bone may last for several days. These stem cells are filtered and frozen until they are needed.
Stem cells may also be collected from umbilical cord blood. After a baby is born, the blood from the placenta and umbilical cord is collected. This blood, which is rich in stem cells, is then frozen and stored until it is needed by someone with a matching tissue type.
You will be admitted to the hospital the day before your transplant. Your doctor or nurse will go over the procedure with you and ways to reduce your risk of infections, such as how to keep your gown sterile and how to prepare your food after the transplant.
The following morning, you will begin several days of high-dose chemotherapy or radiation.
After this therapy is finished, you will get the stored stem cells through an IV that’s attached to a tube. This is similar to a blood transfusion.
When a donor is used for the transplant, you eliminate the chance of lymphoma cells being returned to your body. But you may have more side effects, such as graft-versus-host disease, in which immune cells from the donor start attacking certain organs in your body.
You will then have to wait for your stem cells to start multiplying. This is referred to as engraftment. You may have to stay in isolation to help prevent getting an infection until that happens. Once the part of your white blood cell count called the ANC reaches a certain level (usually about 500), you can come out of isolation. Once it reaches 1,000, you can usually go home. This may take about 3 weeks.
Your blood cell count will be checked every day on an outpatient basis for the next several weeks.
If you get an allogeneic transplant, you may have a treatment called donor lymphocyte infusion (DLI) after the stem cell transplant. The goal is to help put your disease into remission or to keep it there. This treatment involves removing lymphocytes (a type of white blood cell) from the stem cell donor’s blood and freezing them. The lymphocytes are later thawed and given to you in 1 or more infusions. The donor’s lymphocytes will see any remaining lymphoma cells as not belonging to your body and will attack them.