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32

NCCN Guidelines for Patients

®

Mycosis Fungoides, Version 1.2016

3

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

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.

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

next.

HLA typing

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 (

h

uman

l

eukocyte

a

ntigens) typing. A blood sample is needed

to perform the test.

Conditioning treatment

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-

thymocyte globulin.

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

4 weeks.

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.