Bone Marrow Transplant
Resistent, recurring, or advanced Hodgkin lymphoma can significantly reduce the number of healthy blood cells in your marrow. Chemotherapy treatment can destroy the healthy cells in the bone marrow. The loss of these cells will reduce the immune system's ability to fight infections or disease and lead to life-threatening infections. A bone marrow transplant (BMT) uses healthy stem cells (immature, unformed cells) from the bone marrow in your body or a donor to restore normal bone marrow function. The cells travel to bone marrow sites throughout the body and slowly repopulate numbers of red or white blood cells, or platelets. If the transplant is successful, the newly injected cells should be free of cancer and capable of producing healthy cells.
A BMT can be:
Healthy stem cells are harvested from the patient's own body. They can be taken from the bone marrow or extracted from circulating blood. Circulating blood removed from the body is spun in a machine to separate the components in a process called apheresis. The blood is then circulated back into the body. The stem cells are frozen until all malignant lymphoma cells are eliminated by chemotherapy (with or without radiation therapy). Lastly, the healthy stem cells are returned to the body to repopulate the blood cell count.
Allogeneic transplants involve a second person known as a donor. In order for bone marrow transplant to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone marrow cells must match. The recipient is given medications to suppress the immune system and prevent rejection of the donor's bone marrow. Prior to the bone marrow transplant, treatment to eliminate all malignant lymphoma cells from the body may be done (conditioning).
The recipient's bone marrow is harvested with a needle, which removes bone marrow tissue. The donated marrow is filtered and given to the recipient through a vein in the chest. Once the procedure is done, the recipient is isolated to reduce the chance of infection while the healthy stem cells repopulate the blood cell count. It can take up to a month for bone marrow to be fully functional.
Peripheral Stem Cell Transplant
Stem cells can mature into other types of blood cells. Like a BMT, stem cells can come from you or a donor. If they come from you, the stem cells will be removed from the circulating blood before treatment begins. Blood cells are separated through apheresis. The stem cells are may receive treatment to kill any cancer cells that may be present before they are frozen. When it is time for the transplant, the stem cells are returned to the body. The stem cells eventually replace healthy cells that were destroyed during treatment.
This procedure allows for higher doses of chemo- or radiation therapy.
Splenectomy is the surgical removal of the spleen. This organ, located in the upper left part of the abdomen, is part of the lymphatic system. In some cases, the doctor may recommend a splenectomy in people who have Hodgkin lymphoma.
This surgery can often be done laparoscopically through small incisions in the abdomen. It is possible to live without a spleen, but it increases the risk of certain bacterial infections such as pneumonia. Extra protection against some infections can be attained with vaccines and lifestyle changes.
Monoclonal antibody therapy is a form of biologic therapy (also called immunotherapy). Monoclonal antibodies are made in a lab and are used to help the body fight cancer cells by using the body's own immune processes. In the case of Hodgkin lymphoma, a specific medication acts like a natural antibody and attaches itself to cancer cells. The antibody may kill the cancer cell or prevent further growth.
Though therapy with monoclonal antibodies is becoming more common for some forms of cancer, it is usually reserved for people with recurrent Hodgkin lymphoma or Hodgkin lymphoma that is not responding to other treatments.
Medications such as brentuximab and rituximab may help stimulate the immune system to better attack cancer cells. They are given through an IV every few weeks and contain a specific antibody that attaches to lymphoma cells. The antibody signals the chemotherapy medications to the location of the lymphoma cells, causing their destruction before they can divide and multiply. Medications may be given with chemotherapy or at a separate time.
Common side effects include:
- Nausea or vomiting
- Nerve pain
- Rarely, breathing problems and low blood pressure
Treatment During Pregnancy
Treatment of Hodgkin lymphoma depends how fast the cancer is spreading, where it is located, and how far along the pregnancy is. Options include:
- Watchful waiting —The doctor will closely monitor the course of the disease for any changes or progression. This may be an option for Hodgkin lymphoma that is growing slowly and above the diaphragm (a sheet of muscle that separates the chest and abdominal cavities).
- Radiation therapy —Given above the diaphragm with extra protection for the fetus. A lead apron is used to cover the abdomen. Radiation therapy can be used to ease symptoms, like difficulty with breathing.
- Steroid therapy —Used to help ease symptoms, such as swelling and pain.
If the pregnancy is in the first half, treatment may held off or modified until the fetus is 32-36 weeks old. At this point, delivery can be induced and the mother can begin standard treatment. If the pregnancy is in the second half, watchful waiting may be used until delivery can be induced. Comfort measures can be used anytime during the pregnancy.
Adult Hodgkin lymphoma treatment (PDQ)—patient version. National Cancer Institute website. Available at: https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq. Accessed January 28, 2021.
Hodgkin lymphoma (HL). EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114957/Hodgkin-lymphoma-HL. Accessed January 28, 2021.
Immunotherapy for Hodgkin lymphoma. American Cancer Society website. Available at: https://www.cancer.org/cancer/hodgkin-lymphoma/treating/monoclonal-antibodies.html. Accessed January 28, 2021.
Stem cell transplantation. Leukemia & Lymphoma Society of America website. Available at: http://www.lls.org/lymphoma/hodgkin-lymphoma/treatment/stem-cell-transplantation. Accessed January 28, 2021.
Last reviewed December 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP Last Updated: 1/28/2021