Multiple Myeloma

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Treating Multiple Myeloma TOPICS

Stem cell transplant for multiple myeloma

This has become a standard treatment for younger myeloma patients in otherwise good health. Many centers are using this treatment for older patients as well. Several studies have shown that this treatment increases survival compared to standard chemotherapy (chemo).

The first step is to treat the myeloma to reduce the amount of cancer in a patient's body. Many different drug combinations can be used (see the section, "Chemotherapy and other drugs for multiple myeloma").

There are 2 types of stem cell transplant (SCT): autologous and allogeneic.

Autologous stem cell transplant

This type of transplant uses the patient's own blood-forming stem cells. These transplants are fairly safe and have a low risk of serious complications. To collect the patient's stem cells, often the drug cyclophosphamide and a white blood cell stimulating drug are given. Then blood-forming stem cells are removed from the patient's blood by a process called leukapheresis. In this process, blood is removed from the patient or donor, the stem cells are separated by a machine, and then the blood is returned to the patient. In some patients, the stem cells come from their bone marrow.

The stem cells are preserved by being frozen while the patient receives high-dose chemo. This chemo destroys almost all the cells in the patient's bone marrow. This includes the blood-forming stem cells as well as plasma cells. After the chemo, the frozen stem cells are given back to the patient. Stem cells are given IV (in a vein) like a blood transfusion. They travel to the bone marrow and start to grow and make new blood cells.

The chemo can cause many problems. Many patients have high fevers from infections. These are treated with IV antibiotics. Another common problem is mouth sores which can be very painful. Morphine may be given to reduce the pain. The chemo also kills cells in the intestines, which may lead to cramps and diarrhea. Transfusions of red blood cells and platelets are often needed until the bone marrow can again produce enough of these cells.

Because this type of transplant is fairly safe with a low risk of serious complications, it can be used in elderly patients. Unfortunately, even high-dose chemo doesn't kill all the myeloma cells, so the myeloma eventually comes back. Some patients are free of myeloma for quite a long time, but they aren't really cured.

Some doctors recommend that patients with multiple myeloma have 2 autologous transplants, 6 to 12 months apart. This approach is called tandem transplant. Studies show that this may help patients live longer than a single transplant. The drawback, of course, is that it causes more side effects.

Autologous transplants are better than traditional chemo at treating myeloma and can help patients live longer. They are a standard part of myeloma treatment.

Allogeneic stem cell transplant

This type of transplant has more risks than autologous transplants, and so it is used much less often to treat multiple myeloma. For this type of transplant, the stem cells come from someone else. The donor is usually a close relative (like a brother or sister). Less often, an unrelated donor is used, someone whose tissue type is closely matched to the patient. Allogeneic transplants are much riskier than autologous transplants, but they may be better at fighting the cancer. That is because transplanted (donor) cells may actually help destroy myeloma cells. This is called a graft vs. tumor effect.

A patient must be fairly young and healthy to withstand the side effects of this kind of transplant (most myeloma patients are elderly). The transplant also requires a donor matched to the patient. These factors tend to limit the use of this type of transplant in myeloma.

Non-myeloablative stem cell transplant: This is a type of allogeneic transplant in which low doses of certain kinds of chemo drugs are used. The chemo doesn't completely wipe out the bone marrow, but it does enough to let the transplanted stem cells take hold. Then it is hoped that the new cells will kill the myeloma cells (graft vs. tumor effect). Because lower doses of chemo are used, this type of transplant is sometimes called a mini transplant. The lower chemo doses mean that older patients can have this type of transplant.

Last Medical Review: 01/15/2013
Last Revised: 02/12/2013