Stem Cell Transplantation
Cancer treatment, or sometimes the cancer itself, can leave the body unable to produce enough healthy new blood cells. A stem cell transplant, in which healthy blood stem cells are infused into the body typically after high-dose chemotherapy, helps restore this ability. If transplantation is part of your treatment plan, be sure you are aware of what the process entails and how to best prepare for it before and after the procedure.
Types of Transplant
Two main types of blood stem cell transplant are available — autologous (auto) and allogeneic (allo). The goal for both types is to destroy all of the cancer cells in the marrow, blood and other parts of the body. High doses of chemotherapy are used and then replacement blood stem cells are infused to create healthy bone marrow and restore the body's immune response.
An auto transplant uses your own stem cells. If needed, you will receive another transplant six to twelve months later, which is called a tandem stem cell transplant. This transplant is the most commonly used for people with multiple myeloma.
An allo transplant may be used in some cases. It uses donated stem cells that come either from a family member or someone not related to you — often found through a registry (see Donors Save Lives). Along with replacing stem cells, the donated cells may also kill cancer cells that remain after high-dose conditioning. This is called the graft-versus-tumor effect.
A syngeneic stem cell transplant, in which the patient and donor are identical twins, may be an option.
Another option, though very rarely used for multiple myeloma, is a haploidentical transplant. It allows for half-matches, which widely broadens the number of potential
donors. Often, a parent or child is a half-match. In some cases, an extended family member, such as a grandparent, aunt or uncle, may be a donor candidate.
Your doctor can use different sources of stem cells:
- A bone marrow transplant (BMT) uses stem cells from bones. The hip (pelvic) bones have the most marrow, which is why doctors use them most often.
- A peripheral blood stem cell transplant (PBSCT) uses stem cells from the bloodstream. Fewer stem cells are here than in the bone marrow.
- A cord blood transplant uses stem cells from blood vessels of a discarded placenta or newborn’s umbilical cord.
A BMT and a PBSCT may be used for an auto or allo transplant. A cord blood transplant is used for an allo transplant only.
Some allo transplants use milder doses of chemotherapy or radiation therapy (a mini transplant). You may also receive a lymphocyte infusion from the donor to better attack the cancer cells.
Donor tissue needs to match yours as closely as possible. A close match reduces the chance of Graft-versus-Host Disease (GvHD), a serious condition where your body sees the donated cells as foreign and attacks them. A type of white blood cell called a T-cell triggers this reaction.
Understanding The Procedure
Stem cell transplantation is a lengthy process. The time frame varies depending on the type of transplant. The process has four distinct phases:
- Stem cell collection from the patient’s body or donor. The harvesting of stem cells is called apheresis.
- Conditioning with high-dose chemotherapy and/or radiation therapy to destroy the myeloma cells.
- Stem cell infusion of the harvested stem cells back into the patient’s body.
- Engraftment and recovery, in which the healthy cells begin to grow, typically within 30 days. The patient will be at significant risk for infection while the weakened immune system recovers. The number of red blood cells, white blood cells and platelets will continue to be monitored until they reach safe levels.
As you and your doctor discuss this treatment option, be sure to learn as much as you can about the following:
- Expected benefits and risks
- Potential short- and long-term side effects and late effects
- Ways to reduce risk of infection
- The type of help you may need from caregivers and for how long
- Support resources, including help for psychosocial, physical and financial challenges
Understanding Graft-Versus-Host Disease
This potentially serious side effect of an allo stem cell transplant occurs when white blood cells from your donor (the graft) recognize healthy cells in your body (the host) as foreign and attack them. Graft-versus-Host Disease (GvHD) can cause damage to your skin, liver, intestines and many other organs.
Acute GvHD can occur within the first three months after transplant, even if the donor was a 100 percent match. It can be a serious post-treatment complication. Recently, the U.S. Food and Drug Administration approved a drug designed to prevent acute GvHD. Ask your doctor whether you may be a candidate for this preventive therapy.
Another form, chronic GvHD, may occur more than three months after the transplant and may cause short-term or lifelong symptoms.
Symptoms of GvHD can include skin rashes, yellowing skin or eyes (jaundice) and diarrhea. Contact your doctor immediately if you experience any of the following serious effects:
- Dryness of the eyes and mouth
- Tightening, blistering or burning of the skin
- Sudden weight loss
- Abdominal pain or bloating
Donors Save Lives
About 70 percent of people who need a bone marrow transplant do not have a matching family member. For that reason, organizations such as Be The Match (operated by the National Marrow Donor Program) have created life-saving registries of millions of potential donors. African American donors, and donors ages 18-35, are especially needed.
Learn more about the bone marrow donation process and how you may be a match at www.bethematch.org