Autologous Stem Cell Transplant for Lymphoma
Lymphoma is cancer of the Lymphatic system. It occurs when the white blood cells in the body known as Lymphocytes get out of control. They either divide in an abnormal way or they do not die when they should. This happens due to change in genes, the reason of which is unknown.
The Lymphatic system includes the immune system which help fight infections. It contains lymph, a fluid that passes through the lymph nodes and is spread throughout the body. The lymph nodes are found in the neck, armpits, in the chest, abdomen and, groin. The Lymphatic system also consists of organs like the Thymus and Spleen.
In Lymphoma, abnormal lymphocytes can collect in the neck, armpits, or groin although they can also collect in any part of the body like the lungs or liver which is outside the Lymphatic system. The type of Lymphoma one gets influences the symptoms and treatment needed.
Stem cell transplant or bone marrow transplant is done to replace abnormal blood-forming cells with healthy ones. High dosage of chemotherapy or radiation therapy is given to eliminate all blood cancer cells and restore healthy ones through a transplant.
Stem cell transplant is recommended when:
- You have a relapsed Lymphoma after treatment
- Your Lymphoma is refractory – it does not respond to treatment
- As part of your first treatment when the doctor concludes that it is likely to relapse.
In an autologous Stem cell transplant, your own stem cells are collected, frozen, stored and given back to you after a high dose treatment.
Types of Lymphoma
There are more than 60 types of Lymphoma but can be broadly divided into two, namely:
- Hodgkin Lymphoma – It contains Reed-Sternberg cell which is a cell derived from a specific abnormal B lymphocyte lineage
- Non-Hodgkin Lymphoma – It does not have Reed-Sternberg cell, it may be derived from an abnormal B or T cells and are distinguished by genetic markers. It is more common than the other type.
Symptoms of Lymphoma
The symptoms depend on where the Lymphoma started and the parts of body it affects. Some symptoms could be local – in and around the area of the Lymphoma or systemic, affecting the whole body. Depending on the type of Lymphoma, symptoms can vary but the most commons ones are listed below.
- Swollen lymph nodes
- Unexplained weight loss
Diagnosis and tests
- Physical examination
- Blood tests
- CT Scan
- MRI Scan
- PET Scan
- Lumbar puncture
Staging of Lymphoma
In Staging, doctors work out which parts of your body contain Lymphoma so that they could better classify and work out the best combination treatments for each stage. Staging is the same for both types of Lymphoma. There are 4 main stages.
- Stage 1 – A group of lymph nodes affect any area in the body which is either above or below the diaphragm.
- Stage 1E – Known as extra-nodal lymphoma, it started from an organ outside the Lymphatic system and affects only that organ.
- Stage 2 – Lymphoma is present in 2 or more groups of lymph nodes, they can be anywhere in the body either above or below the diaphragm but must be on the same side of the diaphragm.
- Stage 2E – Lymphoma started in one organ and is also in 1 or more groups of lymph nodes, they must be on the same side of the diaphragm.
- Stage 3 – Lymph nodes affect both sides of the diaphragm.
- Stage 4 – The most advanced stage, lymphoma has spread to at least one organ outside the lymphatic system like the lungs, liver, bone marrow, or solid bone.
Lymphoma may be referred to as an “Early” stage if it is on Stage 1 or 2. “Advanced” stage is used when it is on Stage 3 or 4.
Treatment of Lymphoma
Many treatments are available and will be personalized for you depending on your health and the stage you are in. Options include:
- Antibody therapy
- Stem cell transplants
- Targeted drugs
- Thorough physical examination of the body
- Familiarise your doctor with your medical history
- Take diagnostic tests
- You will be asked to stop certain medications if you are currently taking anything like blood thinners etc
- You will be asked to eat a healthy and balanced diet
- You will be asked to stop smoking if you do.
- The first step is harvesting of bone marrow or stem cells from your own
- Local anaesthesia will be given to you
- A needle is inserted in your bone marrow (hip) and the stem cells are collected before the transplant
- The cells are frozen and stored
- After this, high doses of chemotherapy will be given to you, with or without myeloablative therapy to eliminate all healthy and unhealthy cells in the bone marrow
- Your immune system during this time will be weak and you will be closely monitored for risk of infection or complications
- The harvested stem cells are then intravenously transplanted into the blood stream to the bone marrow to reproduce healthy blood cells
- Medications will be given to protect or treat you from infections
- It may take a couple of days to complete each stage and to start the next.
- You may feel sore for some weeks
- You may need to stay in the hospital for a month or so
- Tests will be done to check your blood counts and other vital signs
- Regular blood transfusions and platelets transfusion may be required
- You may suffer from side effects of the therapy
- A personalised meal plan will be developed to strengthen your body after the transplant
- Regular follow-up will be done
- Recovery is lengthy and will take several months.
Risks or complications
Complications could arise from the treatment and are mostly treatable. Some complications are:
- Excessive bleeding
- Side effects of chemotherapy or radiotherapy like nausea, vomiting, hair and skin reactions, loss of appetite
- Damage to organ/s
Factors affecting the cost of autologous Stem cell transplant:
Factors that affect the price includes:
- Stage of Lymphoma
- Location of the hospital
- Medical fees
- Oncologist’s fee
- Duration of hospital stay
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