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Patients Against Lymphoma

 

 Treatments > Stem Cell Transplants / Rescue

Last update: 03/04/2014

Overview

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Planning for your Transplant  marrow.org
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MSKCC About transplants (stem cell rescue) - an excellent overview!
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MSKCC: Transplant (stem cell rescue) innovations
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FL - Oncologist, 2009: Role of Hematopoietic Stem Cell Transplant in the Management of Follicular Lymphoma

"This review aims to clarify recently published data on the application of HSCT in advanced FL."
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FL - Medscape Education: The Role of Hematopoietic Stem Cell Transplant in Follicular Lymphoma
Julie M. Vose, MD; Edward A. Faber, Jr., DO, MS

Full text (Medscape.org requires free registration and login)

Stem cell transplants (bone marrow transplant) - the goal of this treatment is to cure the patient with aggressive therapies that partially or completely kill off (ablate) the normal stem cells in the marrow. These cells are then replaced with the patient's own stem cells - harvested prior to treatment, or obtained from a donor. 

Bone marrow is the spongy tissue found in the cavities of the body's bones, where all the body's blood cells are produced.

Stem cells are immature cells found in the marrow and peripheral blood that develop or mature into red blood cells, white blood cells and platelets.

Types:  allogeneic and autologous are the two main types of stem cell transplantation (or rescue).  Allogeneic stem cells are derived from a matched donor (such as a sibling); in the autologous type, stem cells are derived from the patient.  Each type has unique risks and benefits, and which is preferred can depend on the clinical details. 
 
See for example, one study comparing SCT types  

General exclusion criteria?  "Stem cell transplant (SCT) protocols often require complete response with initial therapy as a requirement for entry, although "good partial remission" may be acceptable at certain centers. *

Other limitations for SCT protocols include age greater than 60 or 65 years, significant chronic obstructive pulmonary, renal, or cardiac disease, a poor performance status, and central nervous system involvement."  *

*  Source: Treatment of relapsed aggressive lymphomas: regimens with and without high-dose therapy and stem cell rescue. 

National Bone Marrow Donor Program 
call 800 MARROW2 ( 800 627-7692 )
 and become a registered donor

BMTInfoNet (Stem Cell Transplant Support)
2900 Skokie Valley Road, Suite B
Highland Park, IL 60035

Search for Stem Cell Transplant Centers  BMTinfoNet
Also provides: background, the number of transplants done, 
Minimum Donor Match Criteria, Contacts, Support Groups Available

Phone: 847.433.3313 - during regular business hours, toll-free 888.597.7674

Be the Match

The Donor Selection & Transplant Process
 marrow.org

In the News

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IMPORTANT * Indications for hematopoietic stem cell transplantation in patients with follicular lymphoma: a consensus project of the EBMT-Lymphoma Working Party

In the absence of randomized controlled trials (RCT) addressing these questions, systematic reviews inevitably fail to provide conclusions helpful for clinical decision making, whereas traditional narrative reviews are prone to be biased by the individual view and expertise of the authors.  Therefore, the European Group for Blood and Marrow Transplantation (EBMT) launched a project to define indications for HDT-ASCR and for allogeneic transplantation in patients with FL in the rituximab era in Europe following a RAND-modified Delphi consensus method.
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Medicare coverage for transplant in lymphoma?  

This document might assist.  It looks like it is covered to us.

 
NC Division of Medical Assistance Medicaid and Health Choice
Hematopoietic Stem-Cell & Clinical Coverage Policy No: 11A-11
Bone Marrow Transplantation Revised Date: March 1, 2012 For Non-Hodgkin's Lymphoma
http://www.ncdhhs.gov/dma/mp/11A11.pdf 
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ASCO POST, May 2013:  Role of Stem Cell Transplantation in [transformed] Follicular Lymphoma ascopost.com

Dr. Armitage is Joe Shapiro Professor of Medicine and Professor and Chair of Oncology, University of Nebraska Medical School, Omaha.
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ASCO POST, May 2013:
Autologous Stem Cell Transplant Improves Survival in Transformed Follicular Lymphoma  ascopost.com 

This retrospective cohort study included 172 patients aged 18 to 65 years with follicular lymphoma and subsequent biopsy-proven aggressive histology transformation.
bullet PubMed: Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention.


Background & Resources

Also see Stem Cell Transplants: When and Which Type?

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Role of Stem Cell transplant in Follicular lymphoma,
Foster,  Gabriel, Shea, 2010 ncbi.nlm.nih.gov
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Full Recovery After Cell Transplantation for Treating Leukemia or Lymphoma 
Can Take 3-5 Years fhcrc.org 

n = 319 adults who had myeloablative (bone-marrow suppression) HCT for treatment of leukemia or lymphoma, 5-year follow-up.
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University of North Carolina Transplant guide for Patients and caregivers PDF
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About Hematopoietic Stem Cell Transplantation  e-medicine
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Review Article: Hematopoietic Cell Transplantation for NHL: Yesterday, Today, and Tomorrow JCO
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Autologous followed by Allogeneic (tandem)  Related PubMed abstracts
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Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: 
Questions and Answers  cis.nci.nih.gov
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Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma -  Blood First Edition Paper July 31, 2003  Summary
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Eligibility Criteria for Stem Cell Transplants  cancer.dartmouth.edu
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Long-term results favor allogeneic over autologous hematopoietic stem cell transplantation in patients with refractory or recurrent indolent non-Hodgkin's lymphoma.
Ann Oncol. 2003 May;14(5):737-44. PMID: 12702528 | Related articles
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Managing Indolent Lymphomas in Relapse  asheducation.org
Working Our Way Through a Plethora of Options (includes SCT guidance) 
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SCT for Low grade Lymphoma  asheducationbook.org /2004 full text | PAL's readable version

"In Section III, Dr. Koen Van Besien provides a well-documented update on outcomes associated with autologous and allogeneic stem cell transplantation for FL. The results of trials of autologous stem cell transplantation in first remission and recent data supporting a role for graft purging are discussed. 

Based on the premise that a graft-versus-lymphoma effect is operative in FL, reduced-intensity allogeneic transplantation is the preferred approach in many cases, and recently reported results are summarized. Criteria for patient selection and the optimal role of transplantation in the overall therapeutic plan for the patient with FL are presented."
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Stem Cell Transplants - Guest Author Series  PLWC.org  (2007)

1) Understanding Bone Marrow and Stem Cell Transplantation   Part I 

2) Bone Marrow and Stem Cell Transplantation: Special types of transplantation  Part II

3) Side Effects of Bone Marrow and Stem Cell Transplantation  Part III

4) Questions and Answers About Bone Marrow and Stem Cell Transplantation  Part IV 
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What Is Induction Therapy?
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Lymphoma subtype-specific
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CLL: PubMed abstracts
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Mantle Cell: 

The Role of Autologous Transplantation in the Management of Mantle Cell Lymphoma: 
A Study From the EBMT E. Vandenberghe, C. Ruiz de Elvira, P. Isaacson, E. Lopez-Guillermo, 
E. Conde, C. Gisselbrecht, F. Guilhot, A. Goldstone, N. Schmitz PDF  
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Resources

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BMTInfoNet (Stem Cell Transplant Support)
2900 Skokie Valley Road, Suite B Highland Park, IL 60035
 

Search for Stem Cell Transplant Centers
 
Provides: Background, Number of transplants done, 
Minimum Donor Match Criteria, Contacts, Support Groups Available

Phone: 847.433.3313 - during regular business hours, toll-free 888.597.7674
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BMT Worksheet - Factors to consider when choosing a center  fhcrc.org - PDF 
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Frequently Asked Questions  Rush Cancer Institute
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What to bring to hospital  cyberfamily
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How long does it take to have an SCT?  AM's story
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Guidelines for preventing infection  mmserver.cjp.com PDF  
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Patient SCT Stories  Cyberfamily

 

Research News

 
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Outcomes
Topic Search: ncbi.nlm.nih.gov
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Long-term survival of patients with resistant lymphoma treated with tandem stem cell transplant. Leuk Lymphoma. 2005 Mar;46(3):405-14. PMID: 15621831 | Related articles
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Stem cell transplantation in follicular lymphoma: progress at last?
Bone Marrow Transplant. 2004 Oct 18 PMID: 15489883 | Related articles 
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Search Official Journal of the American Society for Blood and Marrow Transplantation
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Journal of the American Society for Blood and Marrow Transplantation ENews
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Radioimmunotherapy as part of conditioning for SCT
Topic Search: ncbi.nlm.nih.gov
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Tositumomab (Bexxar) Plus Stem Cell Transplant Induces Remission in Refractory B-Cell Lymphoma  Medscape free login req.

This "interesting approach" increases the possibility of reduction of tumor burden before transplant, Dr. Schrier said. "This looks really promising."
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The Role of Radiolabeled Monoclonal Antibodies as Part of the Conditioning Regimen for Non-Hodgkin’s Lymphoma Autografts John W. Sweetenham ~ University of Colorado Health Sciences Center, Denver, Colorado, USA  static.cjp.com PDF
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High-dose radioimmunotherapy (Bexxar) versus conventional high-dose therapy and autologous hematopoietic stem cell transplantation for relapsed follicular non-Hodgkin's lymphoma: a multivariable cohort analysis. Blood. 2003 May 15 Full Text
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Myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission prolongs progression-free survival [Compared to consolidation with INF] in follicular lymphoma: results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group bloodjournal.org Oct 2004  Commentary 
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Side effects:
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Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions.
Cancer. 2006 Oct 15;107(8):1743-51. Review. PMID: 16977651 

New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections.
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Cognitive function recovers after stem cell transplant  oncolink.org 

To investigate, the researchers initially studied 286 patients who were randomized to be tested pre-transplant and 6 and 12 months, and another 124 were tested at 6 and 12 months. Eighty-three patients who were tested at 12 months only were not included in the analysis.
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Palifermin (Kepivance, Amgen), (rHu-KGF) Improves Quality of Life in Patients Undergoing Stem Cell Transplantation CancerConsultants  
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Cytochrome P450 2C19 loss-of-function polymorphism is associated with an increased treatment-related mortality in patients undergoing allogeneic transplantation. Bone Marrow Transplant. 2007 Oct;40(7):659-64. Epub 2007 Aug 6. PMID: 17680025 

Comment: Probably this finding needs to be validated (reproduced by an independent group) before being declared as true, but it shows how normal variations in patients (a polymorphism) can affect outcomes.  In this case, treatment-related mortality is strongly correlated with a specific normal genetic variation 
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Prognostic
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The impact of histologic grade on the outcome of high-dose therapy and autologous stem cell transplantation for follicular lymphoma  Nature.com 
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Prognostic value of FDG-PET scan imaging in lymphoma patients undergoing autologous stem cell transplantation. Bone Marrow Transplant. 2006 Jun 12; PMID: 16770314 

A positive FDG-PET scan after salvage chemotherapy and prior ASCT indicates an extremely poor chance of durable response after ASCT.
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Infused CD34 cell dose, but not tumour cell content of peripheral blood progenitor cell grafts, predicts clinical outcome in patients with diffuse large B-cell lymphoma and follicular lymphoma grade 3 treated with high-dose therapy. Br J Haematol. 2004 Jun;125(5):605-12. PMID: 15147376  

Also see Lazarus.pdf 
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Comorbidity Index Aids Stem Cell Transplant Choices  Medscape (free login req.) 
  
"reporting co morbidity data of the type used in this index will likely become as important as defining cancer diagnosis, disease stage, remission status, and other more familiar prognostic variables."
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Life After SCT

General:
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Study Finds Overall Health and Quality of Life Intact 10 Years 
After Stem-Cell Transplantation  prnewswire.com
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Guidelines for preventing infection  mmserver.cjp.com PDF 


Re-immunization after SCT?

Question:  When you have a bone marrow transplant does your immune system go back to that of a baby? Do you then have to build immunity to everything all over again? What about things like childhood vaccines? Are they lost?

Yes, the conditioning therapies for SCT are likely to remove or impair immunities to infections gained from natural exposures or vaccinations.  The highest risk for infectious complications is soon after the immune-ablative therapy prior to the reconstitution of the engrafted immune system.2   

The speed with which immune function recovers after HSCT depends on many factors: the type of graft (Allogenic, autologous, syngenic, T-cell repleted, T-cell depleted) 1,6

Immunocompromised patients and their household contacts should not receive some live-attenuated vaccine.

Travel should be avoided if possible and extra precautions should be taken when traveling is necessary. 5

Bottom line:  Please talk with your transplant team regarding the optimal schedule for re-vaccinations and how to minimize risks of infection following recovery from SCT.  You should receive detailed information regarding which immunizations to receive and when. 

  1. Vaccination of stem cell transplant recipients: murciasalud.es  pdf 
    recommendations of the Infectious Diseases Working Party of the EBMT  

    The EBMT produced recommendations for vaccination of SCT recipients in 1995, which were updated in 1999. The United States Center for Disease Control (CDC) published recommendations in 2000. The aim of this paper is to update our previous recommendations. These are graded according to CDC guidelines as described in Table 1 and summarized in Table 2.
  2. Vaccines for Transplant Recipients . Infectious Disease Clinics of North America , Volume 15 , Issue 1 , Pages 273 - 305 D . Molrine , P . Hibberd 
  3. Recovery of immune reactivity after T-cell–depleted bone marrow transplantation depends on thymic activity  bloodjournal.hematologylibrary.org pdf
  4. Vaccinations in stem cell transplant patients (summary) infectiologie.com  Vaccinations.pdf 
  5. Travel vaccines: current practice and future aspects expert-reviews.com/
  6. Bone Marrow Transplantation, Long-Term Effects, immuno-suppressive emedicine.com  
  7. Vaccines following hematological stem cell transplants focosi.altervista.org  
  8. Guidelines for preventing infection  mmserver.cjp.com PDF 

Also See Immunization Guide

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Adjuvants

An adjuvant is an agent that may improve how a therapy works, or that may reduce side effects without compromising efficacy.

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ASH 2002: Proleukin® Plus Rituxan® may Reduce Recurrences Following Stem Cell Transplant in Non-Hodgkin’s Lymphoma  CancerConsultants.com 
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Cytokine improves immune function after bone marrow transplantation in mice www.oncolink.com
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Filgrastim: Treatment of aggressive non-Hodgkin's lymphoma with chemotherapy in combination with filgrastim. Drugs. 2002;62 Suppl 1:33-46. Review. PMID: 12479593  PubMed
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Parenteral glutamine protects hepatic function during bone marrow transplantation.  Brown SA et.al.
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Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy.  J Nutr. 2001 Sep;131(9 Suppl):2578S-84S; discussion 2590S. Review. PMID: 11533316
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Oral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study. Schloerb PR, Skikne BS.  PubMed

Patient Stories 

 
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Stem Cell Transplants: Tips and Questions to Ask   Patient Perspectives and Tips
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Patient experience Mark's Story
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Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright © 2004,  All Rights Reserved.