Multiple Myeloma

Stem Cell Transplantation

Doctors have long relied on stem cell transplants as a way to manage and treat certain hematologic cancers, including multiple myeloma. Two main types of blood stem cell transplantation are available.

Autologous: This type, also referred to as an “auto” transplant, uses the patient’s own stem cells, which are collected, filtered, processed and frozen. High-dose chemotherapy and sometimes full-body radiation (conditioning) are given to destroy the cancer cells. Thawed cells are infused back into the patient’s body. Antibiotics and other drug therapy are given during hospitalization and recovery at home.

A tandem stem cell transplant is sometimes used and involves a second round of high-dose chemotherapy and another autologous stem cell transplant within six months of the first procedure.

Allogeneic: This type may be used for patients with a high risk of relapse, those who aren’t responding fully to other treatments or those who have relapsed disease. Also called an “allo” transplant, it uses stem cells donated by a family member (a sibling has a 1 in 4 chance of being a donor match) or an unrelated donor located through a national or international registry. Stem cells are not typically frozen for an allogeneic transplant.

Graft-versus-Host Disease (GvHD) is common with allogeneic stem cell transplantation and occurs when white blood cells from the donor (the graft) recognize healthy cells in the patient (the host) as foreign and attack them. To reduce the risk of GvHD, it is important that the patient’s and donor’s tissues match as closely as possible. These symptoms require immediate medical attention: dry eyes or mouth; blistering, burning or tightening skin; jaundice; fever; sudden weight loss; or abdominal pain, bloating or diarrhea.

Allogeneic transplantation can work directly against the cancer through the graft-versus-tumor effect (also called graft-versus-leukemia or graft-versus-cancer cell). This may occur when the donor’s white blood cells (the graft) attack any cancer cells (the tumor) remaining after high-dose conditioning treatments.

A reduced-intensity transplant, also called a mini-transplant, may be used in some cases. This procedure uses milder doses of chemotherapy and/or radiation therapy for conditioning. This approach depends entirely on the anti-cancer effect of the new immune system. The patient may also receive a lymphocyte infusion from the donor to boost the attack on cancer cells.

When the patient and donor are identical twins, the procedure is called a syngeneic stem cell transplant.

A newer procedure, called a haploidentical transplant, 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. However, this is very rarely used in multiple myeloma.

After considering the stage of multiple myeloma, the health of your bone marrow, your age, general health and more, the doctor may recommend a stem cell transplant as part of the treatment plan.

As you and your doctor discuss this option, be sure to ask about the benefits and risks, potential short- and long-term side effects, late effects and the length of time you may need help from a caregiver.

About The Procedure

Stem cells used for these procedures may come from one of three different sources: the bloodstream (peripheral blood stem cell transplantation or PBSCT); the marrow inside the pelvic (hip) bone (bone marrow transplantation or BMT); and blood vessels in a newborn baby’s discarded umbilical cord (cord blood transplantation).

Stem cell transplantation is a lengthy process. The time frame varies depending on the type of transplant. The process has four distinct phases:

  1. Stem cell collection from the patient’s body or donor.
  2. Conditioning with chemotherapy and/or radiation therapy.
  3. Stem cell transfusion of the harvested stem cells into the patient’s body.
  4. Recovery and engraftment, 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.

 

Traveling for a Transplant

You are encouraged to find a doctor and a transplant center with extensive experience in stem cell transplantation, which may require traveling. Some treatment centers offer assistance with travel and temporary lodging during treatment. Talk with your health care team at the transplant center and advocacy organizations to learn about the resources available to assist.

To find a center near you, click here

 

Donors are always needed

Patients without a matching family member rely on unrelated donors. About 70 percent of people who need a bone marrow transplant do not have a matched donor in their family. Organizations such as Be The Match (operated by the National Marrow Donor Program) have created registries of millions of potential donors. Minority donors are especially needed.

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