This has become a standard treatment for younger myeloma patients in otherwise good health. Many centers are using this treatment for patients up to age 70. Several studies have shown that this treatment increases survival compared to standard chemotherapy.

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 previous section, "Chemotherapy").

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 cases, bone marrow is used as a source of stem cells.

The stem cells are preserved by being frozen while the patient receives high-dose chemotherapy. This chemotherapy destroys almost all the cells in the patient's bone marrow. This includes the blood-forming stem cells as well as plasma cells. Then, 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 chemotherapy 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 chemotherapy also kills cells in the intestines, which may lead to cramps and diarrhea. Also, since 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.

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

Still, it is not possible to say with certainty that autologous transplants prolong life. Although it is clear that patients will have less myeloma for a while, study results are not in agreement about whether this will extend their life.

Allogeneic stem cell transplant

This type of transplant has more risks than autologous transplants, and so 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 the transplanted (donor) cells may actually help destroy the 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 chemotherapy 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 this type of transplant can be done on older patients.

Last Medical Review: 02/13/2009
Last Revised: 05/12/2009