Is a Stem Cell Transplant Right for You?

A stem cell transplant is most commonly used to treat relapsed diffuse large B-cell lymphoma, she says. But some people with other types of lymphoma, including mantle cell lymphoma, will get an autologous stem cell transplant as soon as they go into remission or get close to it. It’s also an option for some people with indolent (slow-growing) lymphomas that have transformed into more aggressive disease, or those with indolent lymphomas who haven’t responded well to past treatments.

Could You Benefit?

A stem cell transplant isn’t something to enter into lightly. It’s a serious procedure that can cause life-threatening side effects. So before you have this treatment, your doctor will make absolutely sure that you’ll benefit from it.

You’ll need to meet a few criteria, which includes your type and stage of lymphoma, what treatment you received before and how you responded to it, and how likely you are to respond well to a stem cell transplant. Your age is also a consideration, but it’s not as important as you might think.

“Age is just a number,” Dr. Costello says. Whether you’re 50 or 70, “I’m more interested in your fitness level.”

Your doctor needs to consider how healthy you are, and what kind of support you’ll have during and after the procedure. Are you able to take care of yourself? Could you get out and walk a couple of miles a day if you had to? Do you have people who can help take care of you during the transplant process? “What we as a bone marrow transplant group are looking for are the patients who can tolerate side effects,” she says. “Patients who are going to be able to get through an intensive process.”

To determine whether you are fit enough, you’ll undergo a series of medical tests to check the health of your major organs. These tests usually include:

• A health history and physical exam
• Tests to check the status of your lymphoma
• An echocardiogram (EKG) to see how well your heart is working
• A lung function test
• A chest x-ray or computed tomography (CT) scan to check for lung problems
• Blood tests to check your liver and kidney function, as well as to make sure you don’t have any infections

Cleaning Out the Weeds

If your doctor does think you’re a good candidate for a stem cell transplant, you’ll start by getting high doses of chemotherapy. Dr. Costello uses the analogy of cleaning up a garden that’s overrun with weeds. You use chemotherapy to clear out the old weeds “so that you can plant seeds to grow a new garden,” she says. But instead of clearing weeds out of a garden, you’re clearing cancer cells out of diseased bone marrow.

Along with the cancer cells, chemotherapy kills the healthy young cells that will grow into the blood cells you need to carry oxygen around your body, fight infections, and form clots when you injure yourself. Those fledgling cells are called stem cells.

An autologous stem cell transplant takes healthy stem cells from your own body before you start chemotherapy treatment. Once you’ve finished chemo, you’ll get an infusion of those stem cells to replace the ones your treatment destroyed. The stem cells you receive will grow into healthy new blood cells.

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