Resistent, recurring, or advanced non-Hodgkin lymphoma can significantly reduce the number of healthy blood cells in your marrow. Chemotherapy treatment can destroy the healthy cells in the bone marrow. The loss of these cells will reduce the immune system's ability to fight infections or disease and lead to life-threatening infections. A bone marrow transplant (BMT) uses healthy stem cells (immature, unformed cells) from the bone marrow in your body or a donor to restore normal bone marrow function. The cells travel to bone marrow sites throughout the body and slowly repopulate numbers of red or white blood cells, or platelets. If the transplant is successful, the newly injected cells should be free of cancer and capable of producing healthy cells.
A BMT can be:
Healthy stem cells are harvested from the patient's own body. They can be taken from the bone marrow or extracted from circulating blood. Circulating blood removed from the body is spun in a machine to separate the components in a process called apheresis. The blood is then circulated back into the body. The stem cells are frozen until all malignant lymphoma cells are eliminated by chemotherapy (with or without radiation therapy). Lastly, the healthy stem cells are returned to the body to repopulate the blood cell count.
Allogeneic transplants involve a second person known as a donor. In order for bone marrow transplant to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone marrow cells must match. The recipient is given medications to suppress the immune system and prevent rejection of the donor's bone marrow. Prior to the bone marrow transplant, treatment to eliminate all malignant lymphoma cells from the body may be done (conditioning).
The recipient's bone marrow is harvested with a needle, which removes bone marrow tissue. The donated marrow is filtered and given to the recipient through a vein in the chest. Once the procedure is done, the recipient is isolated to reduce the chance of infection while the healthy stem cells repopulate the blood cell count. It can take up to a month for bone marrow to be fully functional.
Red blood cells, platelets, or other blood components may be transfused to increase the number of red blood cells and platelets in people who are short of breath, fatigued, or in danger of serious bleeding. During a blood transfusion, blood and blood products are infused through an IV. If the blood is donated, it will be matched to your blood type before the transfusion. Blood can also be irradiated to prevent tissue rejection. During the transfusion, you will be monitored for any adverse reaction.
Plasmapheresis is a process to exchange plasma in the blood. Plasma is the liquid part that does not contain cells. Excess proteins thicken plasma making it harder to for blood and other substances to circulate. Circulating blood is removed from the body and spun in a machine to separate the plasma from other blood components (apheresis). Once the plasma is cleared of excess proteins, it is returned to the body. Plasma that is returned to the body can be from a donor or a plasma substitute.
Since plasmapheresis does not prevent the blood from thickening again, the treatment may need to be repeated.
Targeted therapy uses medications to seek out cancer cells and destroy them. There are different types of targeted therapy that are used to treat non-Hodgkin lymphoma. Each one blocks specific proteins on the surface of cancer cells. Blocking these proteins inhibits growth of or kills the cancer cells. These include:
Medications, such as rituximab, obinutuzumab, ofatumumab, and ibritumomab may help stimulate the immune system to better attack cancer cells. They are given through an IV every few weeks and contain a specific antibody that attaches to lymphoma cells. Targeted therapy medications can make other treatments, like chemo- or radiation therapy more effective. Because there are so many different types of lymphoma, these medications may be used as first- or second-line treatments, or if other treatments fail.
Common side effects include:
Treatment of non-Hodgkin lymphoma depends if the lymphoma is indolent or aggressive, and how far along the pregnancy is. For indolent lymphomas, watchful waiting may be used until the baby is born. The doctor will closely monitor the course of the disease for any changes or progression during the pregnancy. Some aggressive lymphomas need immediate treatment without watchful waiting. During the first half of the pregnancy, the doctor may advise terminating the pregnancy to start life-saving treatment right away. If the pregnancy is later in the term, it may be possible to induce delivery before treatment begins. Keep in mind that treatments vary depending on the specific type of lymphoma. This course does not apply to everyone who is pregnant.
Non-Hodgkin lymphoma. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003126-pdf.pdf. Accessed April 5, 2016.
Non-Hodgkin lymphoma (NHL). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116014/Non-Hodgkin-lymphoma-NHL. Updated May 5, 2016. Accesses October 6, 2016.
Stem cell transplantation. Leukemia & Lymphoma Society of America website. Available at: http://www.lls.org/lymphoma/non-hodgkin-lymphoma/treatment/stem-cell-transplantation. Accessed April 5, 2016.
Treatment option overview. National Cancer Institute website. Available at: http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_190. Updated March 3, 2016. Accessed April 5, 2016.
Treatment options for non-Hodgkin lymphoma during pregnancy. National Cancer Institute website. Available at: http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_354. Updated March 3, 2016. Accessed April 5, 2016.
Last reviewed March 2017 by EBSCO Medical Review Board Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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