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29

NCCN Guidelines for Patients

®

:

Waldenström’s Macroglobulinemia, Version 1.2017

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 transplant:

†

†

Autologous stem cell transplant uses your own

healthy stem cells to repair bone marrow after

high doses of chemotherapy. This treatment is

also called HDT/ASCR (

h

igh-

d

ose

t

herapy with

a

utologous

s

tem

c

ell

r

escue).

Healthy stem cells will be collected from

you 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, so your healthy stem cells will be

put back into your body to “rescue” your

marrow.

Autologous stem cell transplant is more

commonly used for WM.

†

†

Allogeneic stem cell transplant uses healthy

stem cells that come 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.

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.

A stem cell transplant is not used as a first

treatment for WM. Your doctor might recommend an

autologous stem cell transplant if other treatments

are not working well.

Collecting stem cells

The first step of an autologous stem cell transplant

is to collect, or harvest, the blood stem cells. Blood

stem cells are found in the bone marrow and in the

bloodstream. If stem cells are collected from blood, a

process called apheresis will be done.

1. Medicine is given to increase the number of

stem cells in blood.

2. Some blood will be removed from a large vein

most likely in your arm. It will flow through a

tube and into a machine that removes stem

cells.

3. The rest of the blood will be returned through

another vein.

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.

3

Cancer treatments

Stem cell transplant