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High-dose chemotherapy and stem cell transplant (SCT) is not used as the first treatment for non-Hodgkin lymphoma (NHL) in children, but a transplant may be an option if the first treatment does not work or if the lymphoma comes back after treatment.

The doses of chemotherapy (chemo) drugs normally are limited by the side effects these drugs can cause. Higher doses can’t be used, even if they might kill more cancer cells, because they would severely damage the bone marrow, where new blood cells are made. 

A stem cell transplant (also known as a bone marrow transplant) lets doctors give higher doses of chemotherapy (sometimes along with radiation therapy). After getting high-dose chemo, the child gets a transplant of blood-forming stem cells to restore the bone marrow.

Types of transplants

The main types of stem cell transplants are based on the source of the stem cells. 

• In an autologous stem cell transplant, the child’s own stem cells are used. They are collected several times in the weeks before treatment. The cells are frozen and stored while the child gets treatment (high-dose chemo and/or radiation), and then are given back after treatment into the child’s blood by an IV.
• In an allogeneic stem cell transplant, the stem cells come from someone else (a donor). Usually this is a brother or sister, although the source can be an unrelated donor or even umbilical cord blood. The donor’s tissue type (also known as the HLA type) needs to match the child’s tissue type as closely as possible to help prevent the risk of major problems with the transplant. Regardless of the source, the stem cells are frozen and stored until they are needed for the transplant.

Autologous SCTs are used more often than allogeneic SCTs to treat lymphoma in children. Still, using the child’s own stem cells may not be an option if the lymphoma has spread to the bone marrow. If that occurs, it may be hard to collect stem cells that are free of lymphoma cells. 

Allogeneic transplants aren't used as much to treat lymphoma because they can have severe side effects that make them hard to tolerate. It can also be hard to find a matched donor. 

A stem cell transplant is a complex treatment that can cause serious, possibly even life-threatening side effects. If your child’s doctors think they might benefit from a transplant, it should be done at a center where the staff has experience with the procedure and with managing the recovery phase.

If your child's cancer care team suggests a stem cell transplant, be sure to talk to them beforehand to learn about possible long-term effects your child may have. More information on possible long-term effects can be found in Late and Long-term Effects of Treatment for Non-Hodgkin Lymphoma in Children.