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Stem Cell Transplantation for AIDS-Related Lymphoma
Doctors at NYU Langone’s Perlmutter Cancer Center perform stem cell transplantation to restore blood-forming cells, known as stem cells, after treatment with high-dose chemotherapy. Stem cell transplantation may also be recommended to enhance the effectiveness of white blood cells in responding to treatments such as chemotherapy and radiation.
There are two approaches to performing stem cell transplantation. Your doctor can determine which approach may be most effective for you, depending on which type of lymphoma you have and other treatments you have received.
Autologous Stem Cell Transplantation
Autologous stem cell transplantation uses stem cells that are collected from a person’s own blood before they receive treatment with high-dose chemotherapy. Doctors may recommend using these stem cells for transplantation if lymphoma returns after initial treatment. Autologous stem cell transplantation sometimes cures AIDS-related lymphoma.
Prior to collection, your doctor may give you a medication that causes stem cells to leave the bone marrow and circulate in the blood.
The doctor removes blood through a thin plastic tube called a catheter, which is placed in a large vein in the neck or upper part of the chest. The catheter is connected to a machine that filters out stem cells from blood. The blood is then reinfused into your body through the catheter.
Stem cell collection takes two to three hours a day, over two to four days. The stem cells are frozen and stored until you have completed treatment with high-dose chemotherapy. Then the frozen stem cells are thawed and transfused back into your body. The stem cells travel to the bone marrow, where they begin to make healthy new blood cells.
Allogeneic Stem Cell Transplantation
Stem cells from a healthy donor may also be used for transplantation—an approach called allogeneic stem cell transplantation. Stem cell donors are usually close blood relatives, or another person whose genetic makeup and tissue types are compatible with the recipient’s. This prevents the immune system from attacking the new stem cells as it would any foreign substance.
Before an allogeneic transplant, you receive several days of high-dose chemotherapy with or without radiation therapy. This treatment destroys your remaining healthy bone marrow and suppresses your immune system. Then, doctors give you the donor stem cells with an intravenous (IV) infusion.
After the donated stem cells become engrafted—or implanted—in your bone marrow, they begin making healthy white blood cells.
Some people develop graft-versus-host disease, in which the new immune system attacks the donor stem cells because they appear foreign. This complication can be prevented and managed with medications that suppress the immune system.
Recovery from Stem Cell Transplantation
Either autologous or allogeneic stem cell transplantation requires a hospital stay of several weeks. During this time, NYU Langone specialists carefully monitor you.
High-dose chemotherapy with or without radiation therapy causes blood cell levels to decrease, so 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.
Doctors usually prescribe antibiotics to reduce the risk of infection in people taking immune-suppressing medication for allogeneic transplantation.
After 10 to 14 days, the transplanted stem cells start to make healthy levels of new blood cells. Once your doctors determine you are well enough, you can go home.
Frequent follow-up appointments are necessary because your immune system may be weak for several months. Some people need a longer recovery time after allogeneic transplantation because the immune system is quite weak, and immunosuppressant therapy may be needed for a few months.
NYU Langone offers a variety of support services to help you and your family throughout the stem cell transplantation process.
Stem Cell Transplantation Clinical Trials
NYU Langone conducts clinical trials focusing on how stem cell transplants can become more effective and cause fewer side effects. Your doctor can help you determine whether a traditional or more experimental approach to transplantation is best for you.
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