Should I have a stem cell transplant for non-Hodgkins lymphoma?
I got plasmablastic non-Hodgkins lymphoma (NHL) about a year ago. At the same time I was diagnosed with HIV,with a CD4 of 48.
After chemotherapy,the cancer was in remission. However, 10 months afterwards a small cist was dicovered and I went on another more fierce chemo regime. Again after chemo the CT scan revealed no cancer.
My CD4 after 10 months on Atripla was 178. The doctors requested a stem cell transplant, which failed to yield bone marrow cells after treatment with G-CSF.
Now they are trying a drug called mozobil, to stimulate the growth my stem cells. But this drug is not registered in South Africa, and it’s very expensive.
Should I not rather discard the stem cell transplant and wait for my immune system to recover?
I gained 130 CD4 cells in the first ten months on ARVs.
What would be a safe threshold for my CD4 for my body to keep the cancer at bay?
I do not want to endure the pain of a stem cell transplant if my immune system is recovering.
I’m very sorry to hear about your recent diagnosis. Finding out you have HIV is never easy but finding out you had cancer at the same time must have been very difficult. Do you have any support to help you during this stressful period?
Unfortunately there is no evidence that increasing your CD4 count will extend the period that your cancer stays in remission (especially following second line chemotherapy). The recovery of CD4 count after chemotherapy helps with reducing the risk of opportunistic infections and new AIDS defining malignancies. But it doesn’t mean the cancer won’t come back.
The evidence for autologous stem cell transplants in second remission of plasmablastic lymphoma does not exist, it just seems like a sensible idea. Most clinicians would suggest that second-line treatment for relapsed aggressive NHL in the general population should be with induction chemotherapy followed by high dose chemotherapy and autologous stem cell transplantation (if the induction chemotherapy works).
In your situation the induction chemotherapy was used to shrink down the relapsed lymphoma as much as possible. The high dose chemotherapy with stem cell transplant would be used to try to eradicate and remaining often microscopic lymphoma. If only the induction chemotherapy is used then it is not much more that the first line treatment really and we know that the first line treatment was insufficient to cure the lymphoma. The absence of active residual disease on scans does not mean that there is no need for the high dose chemotherapy and stem cell transplant.
This is a difficult area and to answer your question I consulted a UK specialist in HIV related cancers. The information he gave me suggests that the treatment your doctors have suggested is the same as would be offered in the UK. It’s important that you talk through your concerns with your doctors though. With their help you can weigh up the pros and cons of going ahead with (or avoiding) this treatment.
Further information about non-Hodgkin’s lymphoma: