Multiple Myeloma Overview

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Treating Multiple Myeloma TOPICS

Stem cell transplant for multiple myeloma

This has become the standard treatment for younger myeloma patients in good health. It allows higher doses of chemotherapy (chemo) to be used. Many centers are using this treatment for older patients, too. Studies have shown that this treatment increases how long patients live compared to standard chemo.

The first step in the transplant process is to lower the amount of cancer in a patient’s body. This is done with chemo and other drugs. At the same time, blood-forming cells are taken from the patient’s (or a donor’s) blood or bone marrow. These cells, called stem cells, are then frozen.

Next, the patient gets high-dose chemo to kill any myeloma cells left behind. The treatment also destroys all the bone marrow stem cells. This would normally kill the patient. But the frozen stem cells are given to the patient after chemo. They are put into the bloodstream through an IV. The stem cells travel to the bone marrow where they begin to make new blood cells.

There are 2 types of stem cell transplant (SCT):

Autologous transplant

If the patient’s own stem cells are used, it is called an autologous transplant. These transplants are fairly safe and have a low risk of serious complications. Because of this, they can be used for older patients. But it is hard to kill all the myeloma cells with high-dose chemo. Most patients who have autologous transplants will have their myeloma return later. A few patients will be free of myeloma for a long time, but this procedure doesn’t cure the disease.

The high doses of chemo used in autologous transplant 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. Since the bone marrow is unable to make blood cells, transfusions of red blood cells and platelets are often needed. When the new stem cells start making new blood cells, the transfusions are no longer needed.

Autologous transplants are better than regular chemo at treating myeloma and help patients live longer. They are a standard part of myeloma treatment. Some doctors recommend that patients 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.

Allogeneic transplant

When stem cells from a donor are used, the transplant is called an allogeneic transplant. The donor is usually a close relative. Less often, it is an unrelated person whose tissue type closely matches that of the patient. Allogeneic transplants carry a higher risk of severe complications, even death. But they may lead to longer remissions. This is because the donor’s immune system cells may help to destroy the myeloma cells. Allogeneic transplants are not used often in myeloma patients. There are 2 reasons for this: First, the patient must be fairly young and healthy to withstand the side effects of transplant — most myeloma patients are elderly. Second, a donor’s tissue type must match the patient’s. These matches can be hard to find.

Mini-transplant: Some allogeneic transplants use low doses of certain kinds of chemo drugs to allow the transplanted stem cells to “take” without all the side effects of high doses. This is sometimes called a “mini-transplant” or a non-myeloablative transplant. This type of transplant allows the treatment to be done on older patients. Although the myeloma hasn’t been destroyed by the low-dose chemo, the transplanted stem cells are expected to act against the myeloma cells and destroy them. Although this type of transplant has fewer risks than a standard allogeneic transplant, it can still have serious side effects.

Last Medical Review: 02/01/2013
Last Revised: 02/13/2013