Hodgkin's Disease - Transplantation

Highlights	Outlook	Transplantation
Introduction	Staging and Treatment Guidelines	Immunotherapy
Risk Factors	Treatment Options by Stage	Resources
Symptoms	Radiation Treatments	References
Diagnosis	Other Treatments

Transplantation

Patients with relapsed or progressive HD are often treated with high-dose chemotherapy followed by stem cell transplantation procedures. (It does not appear to offer an advantage compared to standard chemotherapy as initial treatment for patients with high-risk advanced HD.)

text continues below

This treatment involves removal and replacement of stem cells, which are produced in the bone marrow. This allows the patient to receive high-dose chemotherapy without destroying these important cells. Stem cells are the early forms for all blood cells in the body (including red, white, and immune cells). Cancer treatments harm growing cells as well as cancer cells, and so the healthy stem cells must be replaced by transplanting them, usually using the patients own cells (called an autologous procedure) or, less commonly, from a donor (allogeneic procedure).

Collecting the Stem Cells

Sources of Cells. Stem cells must first be collected in one of the following ways:

Directly from blood (peripheral blood stem cell transplantation)
From bone marrow (bone marrow transplantation)
From umbilical cords or placentas

Click the icon to see an illustrated series detailing bone marrow transplant surgery.

Current evidence suggests that the stem cell and bone marrow procedure produce similar benefits in terms of survival. However, because stem cell transplantation seems to be superior in terms of cost, quality of life, and the need for less supportive care, it is discussed here.

Donor or Patient Cells. The marrow or blood stem cells can be taken from the patient (autologous) or from a matched donor (allogeneic):

An autologous transplant is one in which marrow or blood cells used are the patient's own. Autologous stem cell transplantation is the current preferred choice for HD patients who need these procedures. The advantage to an autologous procedure is that the patient is not at risk for rejection by the immune system. There is some danger, however, that the cells used may contain tumor cells and the cancer can regrow. There is also a higher risk for leukemia (This risk is lower in peripheral stem cells transplants than in bone marrow transplants.) A number of studies, however, are reporting good success with this transplant.
An allogeneic transplant is one in which bone marrow or stem cells are taken from a donor. The donor and recipient must be matched as closely as possible to avoid rejection by the immune system, a serious complication called graft-versus-host disease. Siblings are the best possibility.