Stem Cell Transplant for Waldenstrom Macroglobulinemia

Stem cell transplant (SCT) can sometimes be used to treat Waldenstrom macroglobulinemia (WM). You might also hear this called a bone marrow transplant or hematopoietic stem cell transplant.

SCT is not a common treatment for Waldenstrom macroglobulinemia, but it might be an option for younger people if other treatments are no longer working.

Why are stem cell transplants used for WM?

Typically, the doses of chemo doctors can give are limited by the side effects they cause, like damage to the bone marrow. Higher doses of chemo may be more effective in killing the cancer cells that make abnormal proteins in WM. But the damage done by these high doses can cause serious or even life-threatening side effects.

SCT allows doctors to give these higher doses of chemo by replacing your blood-forming stem cells and immune system after they are destroyed by the chemo.

How is SCT different from solid organ transplants?

Compared to solid organ transplants that work immediately, SCT instead “plants the seeds” that allow new bone marrow to grow and make blood cells.

It can take weeks to months after getting new stem cells before your bone marrow is fully able to make all the blood cells on its own.

To learn more about how an SCT is done, see Stem Cell Transplant for Cancer.

Types of stem cell transplant used for WM

There are two main types of stem cell transplant (SCT) that may be considered in treating WM.

• Autologous SCT uses your own blood-forming stem cells. This is the most common type of transplant used for WM.
• Allogeneic SCT uses blood-forming stem cells from a donor. This is still being studied for WM, and experts recommend it be done only as part of a clinical trial.

Autologous (auto) stem cell transplant

Autologous (auto) stem cell transplant is the most common type of transplant used for WM.

For an auto transplant, your own blood-forming stem cells are collected (harvested) from your bloodstream and stored to use later. You are then given high doses of chemo (and sometimes radiation) to kill the WM cells in your body.

The high doses of chemo kill the normal bone marrow cells along with the cancer cells. After you finish chemo, your frozen stem cells are thawed and returned to your body like a blood transfusion.

Auto transplants can help some people with WM, but doctors are still trying to figure out which patients will benefit the most.

Allogeneic (allo) stem cell transplant

In an allogeneic SCT, the stem cells for the transplant come from someone else (a donor). The donor’s tissue type (also known as the HLA type) needs to match your tissue type as closely as possible to help prevent the risk of major problems with the transplant.

This donor may be a relative if they have the same tissue type. If there are no relatives with a good match, the cells may come from an HLA-matched, unrelated donor. This is a stranger who has volunteered to donate cells. You can learn more about HLA matching in Finding a Stem Cell Donor.

Allogeneic transplants have more risks and side effects than autologous transplants, so people typically need to be younger and relatively healthy to be good candidates. Another challenge is that it can sometimes be difficult to find a matched donor.

Allogeneic SCT has a few benefits that auto SCT does not. For example, the donor cells in allogeneic SCT grow and partly take over your own immune system. These donor cells can then attack the WM cells. This is known as a graft-versus-lymphoma effect.

Possible side effects of stem cell transplant

Stem cell transplants are complex treatments and can have side effects.

Early side effects of SCT include:

• Nausea and vomiting
• Fatigue
• Hair loss
• Low appetite
• Mouth sores
• Diarrhea
• Infections
• Low blood counts

Graft-versus-host disease (GVHD): Allogeneic transplants may also be complicated by GVHD. This is a condition where the donor’s immune system attacks your normal cells. This can cause problems throughout your body, including in your skin, lungs, liver, intestines, and elsewhere.

Late- and long-term side effects: Some complications and side effects can last for a long time and might not happen until months or years after the transplant. These side effects may depend on the type of chemo (or radiation) given before SCT.

Learn more about this in Stem Cell or Bone Marrow Transplant Side Effects.

Deciding to get a stem cell transplant for WM

A stem cell transplant is a complex treatment that can cause life-threatening side effects because of the high doses of chemotherapy.

If your cancer care team thinks you can benefit from a transplant, the best place to have this done is at a cancer center where the staff has experience with the procedure and managing the recovery period.

An SCT is a complex and intense treatment. Even if the transplant is done outside the hospital, someone will need to be with you to help care for you for the first few weeks to months after treatment. You will likely have frequent visits to the doctor, and the treatment can be very expensive.

Even if the transplant is covered by your insurance, your co-pays or other costs could easily amount to many thousands of dollars. Before the transplant, it’s important to find out what your insurer will cover to get an idea of what you might have to pay.

Be sure to talk to your cancer care team before the transplant to learn about the possible long-term side effects you might have.