NCCN Guidelines for Patients
Mycosis Fungoides, Version 1.2016
Overview of cancer treatments Stem cell transplant
Stem cell transplant
Hematopoietic stem cells are cells that develop
into mature blood cells. Hematopoietic stem cells
and mature blood cells are made in bone marrow.
Cancer or its treatment can damage or destroy the
cells in bone marrow. A stem cell transplant replaces
damaged or destroyed stem cells with healthy stem
cells, which form new marrow and blood cells.
There are two types of stem cell transplants.
Autologous stem cell transplant uses your healthy
stem cells to repair bone marrow after high-dose
chemotherapy. This type of transplant does not work
well for mycosis fungoides and is not used.
Allogeneic stem cell transplant uses healthy blood
stem cells that come from a donor. The goal of an
allogeneic transplant is to create a new immune
system in your body. This is done by suppressing
your bone marrow and killing the cancer then
transplanting healthy blood stem cells. The healthy
stem cells will form new bone marrow and attack
remaining cancer cells. This attack is known as the
umor) effect. On the other hand,
there is a serious risk of GVHD (
isease). GVHD is when the donated cells see the
cells in your body as foreign and attack them.
An allogeneic transplant may be an option after other
treatments have not worked. There is no overall
agreement on its role in treating mycosis fungoides.
It is a complex treatment and can cause severe
side effects, including death. Thus, it may not be a
good treatment choice for most people with mycosis
fungoides. More details on this transplant are given
Special testing must be done to find the right donor
for you. The donor and your tissue type must be a
near-perfect match for this treatment to work. The
test used to check tissue type is called HLA (
ntigens) typing. A blood sample is needed
to perform the test.
Before the transplant, you will receive treatment that
will suppress your immune system allowing the donor
cells to grow. This is called conditioning treatment.
High-dose chemotherapy has typically been used
for conditioning. Not every person can tolerate the
high-dose chemotherapy before the transplant. As
such, nonmyeloablative transplants have been tested.
These transplants use lower doses of chemotherapy
or newer methods to reduce the severity of side
effects. Newer methods include total skin electron
beam therapy, total lymphoid irradiation, and anti-
Transplanting stem cells
After chemotherapy, you will receive the healthy stem
cells through a transfusion. A transfusion is a slow
injection of blood products through a central line into
a large vein. A central line (or central venous catheter)
is a thin tube. The tube will be inserted into your skin
through one cut and into your vein through a second
cut. Local anesthesia is used. This process can take
several hours to complete.
The transplanted stem cells will travel to your bone
marrow and grow. New, healthy blood cells will form.
This is called engraftment. It usually takes about 2 to
Until then, you will have little or no immune defense.
You may need to stay in a very clean room at the
hospital. You may be given an antibiotic to prevent
or treat infection. You may also be given a blood
transfusion to prevent bleeding and to treat anemia.
While waiting for the cells to engraft, you will likely
feel tired and weak.