NCCN Guidelines for Patients® | Diffuse Large B-cell Lymphoma

33 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 Blood stem cell transplant Blood (hematopoietic) stem cells are cells from which all blood cells are formed. They mainly exist in bone marrow. Cancer or its treatment can damage or destroy blood stem cells. A blood stem cell transplant replaces damaged or destroyed stem cells with healthy stem cells. The healthy stem cells form new marrow and blood cells. There are two types of blood stem cell transplants. Autologous blood stem cell transplant Autologous blood stem cell transplant uses your healthy stem cells to repair bone marrow. This treatment is also called HDT/ASCR ( h igh- d ose t herapy with a utologous s tem c ell r escue). Your healthy stem cells will be collected when imaging tests show that cancer treatment is working. You will then receive intense chemotherapy and maybe radiation to destroy any remaining cancer cells. This intense treatment will also destroy bone marrow. Your healthy stem cells will be put back into your body to “rescue” your marrow. Allogeneic blood stem cell transplant Allogeneic blood stem cell transplant uses healthy stem cells from a donor. HLA ( h uman l eukocyte a ntigen) typing is the test used to check if the donor and your tissue type are a good fit. Chemotherapy will be given to destroy cancer cells and suppress your immune system from attacking the donor cells. The transplanted stem cells will form new marrow and attack remaining cancer cells. This attack is known as the GVT ( g raft- v ersus- t umor) effect. On the other hand, there is a serious risk of GVHD ( g raft- v ersus- h ost d isease). GVHD is when the donated cells see the cells in your body as foreign and attack them. What to expect A blood stem cell transplant is not an option for everyone. It can have severe side effects. Thus, it is not given to people who are frail or quite sick. Autologous blood stem cell transplant is more commonly used for DLBCL. Sometimes it is used if initial treatment doesn’t work or the cancer re- appears on tests. More details on this transplant are given next. Collecting your blood stem cells The first step of an autologous blood stem cell transplant is to collect your blood stem cells. Blood stem cells are found in the bone marrow and in the bloodstream. The methods to harvest differ based on collecting from marrow or blood. If stem cells are collected from blood, a process called apheresis will be done. First, medicine is given to increase the number of stem cells in blood. Then, some blood will be removed from a large vein most likely in your arm. The blood will flow through a tube and into a machine that removes stem cells. The rest of the blood will be returned through the other arm. Apheresis typically takes 4 to 6 hours and does not require anesthesia. It may take two or more sessions to obtain enough stem cells. During the procedure, you may have lightheadedness, chills, numbness around the lips, and cramping in the hands. Bone marrow aspiration is used to remove bone marrow. For this procedure, either regional anesthesia or general anesthesia is given. Next, a needle will be inserted through the skin into the hip bone to draw out the bone marrow. The needle must be inserted many times into one or more spots to collect enough marrow. The marrow will then be processed to collect the stem cells. Collection of the bone marrow takes about 1 hour. The entire hospital stay will likely be 6 to 8 hours, 3 Overview of cancer treatments Blood stem cell transplant