CAR T cell therapy is a new way to treat some cancers. This video explains what CAR T cell therapy is, who it may be for, and the risk and benefits of the treatment.
What is non-Hodgkin lymphoma (NHL)?
NHL is a group of blood cancers. In NHL, the body makes unhealthy lymphocytes. Lymphocytes are a type of white blood cell. They help your body fight infections. In NHL, the lymphocytes don’t fight infections very well. They also form tumors in the lymph nodes and other places in the body. The tumors can make lymph nodes bigger, usually around the neck, under the armpits and in the groin. They may also collect in different parts of the body, including the liver, spleen and bone marrow.
There are more than 30 different types of NHL. The different types are based on how quickly the unhealthy lymphocytes grow and the type of lymphocytes affected. Lymphomas that grow slowly are called indolent lymphomas. Aggressive lymphomas are ones that grow quickly. The unhealthy lymphocyte types can be B cells, T cells or NK cells. Most are B-cell lymphomas.
The most common types of NHL are:
- Follicular lymphoma—a slow growing (indolent) B-cell lymphoma
- Diffuse large B-cell lymphoma (DLBCL)— an aggressive B-cell lymphoma
- Mantle cell lymphoma—an aggressive B-cell lymphoma
How does blood or marrow transplant (BMT) work for NHL?
BMT, also known as a bone marrow transplant or blood stem cell transplant, replaces the immature (blood-forming cells) cells that grow into unhealthy lymphocytes with healthy ones. For some people transplant can cure the NHL.
There are 2 types of transplant for NHL:
- Autologous transplant uses the patient’s own blood-forming cells, which are collected and stored. Then, they’re given back after chemotherapy (chemo) or radiation.
- Allogeneic transplant uses healthy blood-forming cells from a family member, unrelated donor or umbilical cord blood.
Autologous transplant is more commonly used for NHL. For aggressive NHLs, allogeneic transplant is used if chemo doesn’t work or if the lymphoma returns after an autologous transplant.
For both types of transplant, first you get chemo, with or without radiation, to kill the unhealthy cells. Then, the replacement cells are given to you through an intravenous (IV) catheter. The cells travel to the inside of your bones and begin to make healthy blood cells.
The entire transplant process, from the start of chemo or radiation, until hospital discharge, can last weeks to months. This is followed by many months of recovery near the transplant center and at home. Your transplant team will closely watch you to prevent and treat any side effects or complications.
When should I see a transplant doctor?
If you have follicular lymphoma, see a transplant doctor if:
- It doesn’t get better with initial treatment
- The initial remission (no signs of disease) lasts less than 1 year
- It comes back a 2nd time
- It turns into a more aggressive lymphoma
If you have DLBCL, you should see a transplant doctor if:
- It comes back after initial treatment
- The initial chemo doesn’t lead to remission
If you have mantle cell lymphoma or other high-risk lymphomas, you should see a transplant doctor at diagnosis or soon after you start treatment.
Your first appointment with a transplant doctor
At your first appointment, the transplant doctor will:
- Review your medical history
- Talk with you about your treatment options
- Discuss the risks and benefits of transplant
- Recommend the best time for you to get a transplant, the best type of transplant, and help you prepare for treatment
Questions to ask your doctor
Ask questions so you understand your treatment options and can make decisions that are best for you. Questions you may want to ask your doctor include:
- What are my chances of a cure or long-term remission if I get a transplant? If I don’t get a transplant?
- What are the risks of waiting or trying other treatments before a transplant?
- Does my current health or age affect how well transplant might work for me?
- What are the possible side effects of transplant? How can they be reduced?
- How might my quality of life change over time, with or without transplant?
Most recent medical review completed March 2017.