Stem Cell Transplantation for Cutaneous T-Cell Lymphoma
Doctors at NYU Langone may use allogeneic stem cell transplantation to manage cutaneous T-cell lymphoma that is growing rapidly and not responding to skin-directed or whole-body treatment or to photopheresis.
Stem cells are immature blood cells that reside in the marrow within the bones, located throughout the body. Stem cells develop into red blood cells, which provide oxygen to tissue; white blood cells, which fight infection; and platelets, which help with blood clotting.
An allogeneic stem cell transplant involves replacing your damaged bone marrow cells with healthy stem cells from a donor—usually a close blood relative or someone who is a genetic match with similar blood and tissue types—after you receive high-dose chemotherapy, with or without radiation therapy. This process preserves blood cell production, while allowing doctors to treat the disease in the most effective way possible.
Another important benefit of allogeneic stem cell transplantation is that it can create an immune response against cancer cells. Donor stem cells can develop into healthy white blood cells that help destroy any remaining cancerous T-cell lymphocytes on the skin and throughout the body.
Allogeneic transplant requires undergoing several days of high-dose chemotherapy—medications that destroy cancer cells throughout the body—delivered through intravenous (IV) infusion given in the hospital. High doses of chemotherapy drugs can help to destroy any cancerous T-cell lymphocytes even when standard whole-body medications are no longer effective.
Radiation therapy—the delivery of high levels of energy to help destroy cancer cells—may also be given during this time as part of a clinical trial. Radiation therapy is used to treat the whole body, and can be effective against lymphoma. Treatment sessions may occur one to three times a day.
Another important reason for giving high doses of chemotherapy with or without radiation therapy is that it destroys your own stem cells, which helps to suppress the immune system so it more readily accepts the donor cells. Doctors can also prescribe drugs to help suppress the immune system. When chemotherapy, with or without radiation therapy, is complete, doctors transfuse the donor stem cells into your body with an IV catheter. The stem cells then travel to the bone marrow, where, over time, they begin to make new blood cells.
One potential complication of allogeneic transplantation is that stem cells from the donor may recognize your body as foreign, a condition called graft versus host disease. Your body may also recognize the donor stem cells as foreign, creating an unhealthy immune response. These potential complications are closely monitored and can be prevented and managed during treatment with medications that suppress the immune system.
Recovery from Stem Cell Transplantation
People undergoing allogeneic stem cell transplantation are in the hospital for several weeks. During this time, our doctors carefully oversee your care.
Because high-dose chemotherapy causes blood cell levels to decrease, most people require blood transfusions after transplantation. Transfusions may include red blood cells to treat anemia and its associated fatigue and platelets to prevent problems with clotting.
Because white blood cells are also low and people undergoing allogeneic stem cell transplantation have to take medications that suppress the immune system, their risk for infection is high. During recovery, doctors closely monitor you and prescribe antibiotics to prevent infection.
Usually after 10 to 14 days, the transplanted stem cells start to make healthy levels of new blood cells. When your doctors determine you are well enough, you can go home. Frequent follow-up appointments are needed because your immune system may be weak for several months or longer. Some people with cutaneous T-cell lymphoma may experience a remission with allogeneic stem cell transplantation, meaning the signs and symptoms of the condition go away. Remission can last for several years.
NYU Langone offers a number of physical and psychological support services for people who have undergone stem cell transplantation to help with the recovery process.