If cutaneous lymphoma recurs after treatment and numerous other treatments have been tried and are no longer effective, a stem cell transplant may be considered. A stem cell is an immature cell in the bone marrow that can develop into mature blood cells. Stem cell transplantations are serious treatments that should not be taken lightly or considered early in a patient’s disease journey and may not be suitable for all patients. For a stem cell transplant, patients are given high doses of chemotherapy or radiation, which kills stem cells in the bone marrow that develop into blood cells. The bone marrow cells are then replaced with the patient’s own healthy stem cells stored prior to treatment (autologous stem cell transplantation) or those from a genetically matched donor (allogeneic stem cell transplantation). Of these 2 types of transplants, allogeneic stem cell transplantation is the only procedure used for patients with CTCL. These stems cells will form new, healthy white blood cells.
The ability to transplant stem cells allows physicians to use higher doses of chemotherapy to treat the cancer than the patient could normally tolerate. High-dose chemotherapy can destroy not only cancer cells, but also healthy bone marrow needed to maintain a patient’s blood cells. After high-dose chemotherapy, which is sometimes given with radiation, blood cell counts are low, which increases a patient’s risk of infection, and the ability of the blood to clot is reduced, which may increase the risk of bleeding. In addition, because the chemotherapy doses are higher, side effects from the chemotherapy may be more intense, especially immediately following transplantation and for a few weeks afterward. Patients with adverse health conditions or those who are more advanced in age may be at higher risk while undergoing this procedure.54
Steven Horwitz, MD, Medical Oncologist, Memorial-Sloan Kettering Cancer Center
Lauren Pinter-Brown, MD, FACP, Professor, Department of Medicine, Division of Hematology/Oncology, UC Irvine Medical Center (At time of publication: UCLA Medical Center)
Because patients with adverse health conditions and/or those with more advanced age are put at higher risk when their bone marrow is destroyed, they may be candidates for reduced-intensity transplantation (also called non-myeloablative or mini-allogeneic stem cell transplantation). During this procedure, reduced-intensity treatment kills some of the cancer cells and some of the bone marrow, suppressing the immune system just enough to allow the donor’s stem cells to be taken up. The cells from both the donor and the patient exist together in the patient’s body. Slowly, the donor’s cells take over the patient’s bone marrow. These new donor cells may be capable of responding to the cutaneous lymphoma by helping the patient’s immune system kill the cancer cells. This is a less intense approach than full stem cell transplantation. This approach is being investigated more thoroughly and may become adopted by more physicians for the treatment of a broader range of patients if it proves to be sufficiently effective in healthier patients.
Jasmine Zain, MD, Director, T-cell Lymphoma Program, City of Hope Comprehensive Cancer Center
Lauren Pinter-Brown, MD, FACP, Professor, Department of Medicine, Division of Hematology/Oncology, UC Irvine Medical Center (At time of Production: Clinical Professor of Medicine, Geffin School of Medicine at UCLA)
With allogeneic stem cell transplantation, there is a risk of graft-versus-host disease (GVHD). Immune cells are able to detect “foreign” tissues. GVHD occurs when the new stem cells from the donor see the recipient’s body cells as foreign and attack them. GVHD is a common condition that can either be a minor problem or a very serious one. It is usually controlled with drugs that suppress the immune cells to keep them from attacking the recipient’s cells.
Stem cell transplantation is an area of great interest to many leaders in the field. There is significant discussion and investigation into determining the best approach for treating patients with CTCL.
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