Multiple Myeloma: Stem Cell Transplant
What is a stem cell transplant?
Stem cells are immature cells that are the starter cells for all types of body tissues. A stem cell transplant uses stem cells to replace bone marrow that contains cancer. This used to be called a bone marrow transplant.
The cancer treatments chemotherapy and radiation can destroy bone marrow. Healthy stem cells are then put in your body. These stem cells will grow and become new and healthy bone marrow cells, which can then make new blood cells.
When might a stem cell transplant be used for multiple myeloma?
A stem cell transplant is often part of the treatment for multiple myeloma if a person is healthy enough to tolerate it. While a stem cell transplant does not cure multiple myeloma, it can often help people live longer.
A stem cell transplant is normally done after the first course of medicine treatment to lower the number of myeloma cells in the body. This might include targeted medicine, chemotherapy, or immunotherapy.
Some healthcare providers recommend that people get two stem cell transplants, several months apart. This approach is known as a tandem transplant. It can help people live longer, but it can also cause more side effects.
Types of stem cell transplants
There are 2 kinds of stem cell transplants. These include:
Autologous transplant. This means the stem cells are collected from your own body and preserved. This is done before you get chemotherapy.
Allogeneic transplant. This means the stem cells come from another person whose cell type is almost exactly like yours. This may be a brother or sister.
For multiple myeloma, autologous transplants are preferred. These transplants tend to have fewer side effects. It hasn't been shown that allogeneic transplants work any better.
How stem cells are collected
Stem cells may be collected in a couple of ways.
From the blood
This is the most common source of stem cells for a transplant. You or your donor may get an injection of a growth factor medicine for several days. This medicine helps stimulate stem-cell production. The process for collecting stem cells from the blood is called apheresis. It’s a lot like giving blood, but it takes longer. A thin, flexible tube (catheter) is used to get blood from your vein or from a donor. The blood goes to a cell separation device to remove the stem cells. The stem cells are then frozen until later. Then the extra blood is returned to you or the donor. You may have a strange taste in your mouth during the process. This is from the preservative used to freeze the stem cells. This process may need to be done more than once to collect the right number of cells.
From the bone marrow
Stem cells may also be taken from the bone marrow of you or the donor. This process is done while you or your donor is asleep with general anesthesia. A healthcare provider makes several punctures in your pelvic or hip bone to remove marrow. Your hips bone may be sore for several days. These stem cells are filtered and frozen until they are needed.
Having the transplant
You’ll be admitted to the hospital the day before your transplant. Your healthcare provider will go over how to keep your gown sterile, how to prepare your food after the transplant, and other ways to help you avoid germs. You need to do this to lower your risk of infections.
After your chemotherapy or radiation is done, you’ll receive the stored stem cells through a needle in your arm that’s attached to a tube. This is like a blood transfusion.
You’ll have to wait for your stem cells to start multiplying. You may have to stay in isolation away from people to avoid getting an infection. Once the part of your white blood cell count (absolute neutrophil count) reaches a safe level, you can come out of isolation and eventually go home. This may happen within several weeks, or it may take longer.
You’ll need to have your blood drawn often. This is done to check your blood cell count for the next several weeks. This can be done on an outpatient basis.
Possible short-term side effects
Most of the short-term side effects of a stem cell transplant are from the high doses of chemotherapy or radiation. These should go away as you recover. Common side effects can include:
Low blood cell counts
Low blood pressure
Shortness of breath
Chest pain or tightness
Fever or chills
Loss of appetite
Possible long-term side effects
Some side effects of a stem cell transplant may be long-lasting or show up years later. These can include:
Bone pain. This is caused by damage due to lack of blood supply (aseptic necrosis).
Growth of another cancer
Damage to other organs. These can include your heart, kidneys, or liver.
Lack of menstrual periods. This may mean ovary damage and cause infertility.
Vision problems. This is caused by damage to the lens of your eye.
Weight gain. This may be a sign of thyroid gland damage.
Another possible long-term side effect is graft-versus-host disease. This can only occur with an allogeneic transplant. It happens when immune system cells from the donor attack your body. The cells can attack your skin, liver, gastrointestinal tract, mouth, or other organs. This can cause symptoms such as:
Skin rashes with itching
Yellowing of your skin (jaundice)
Talking with your healthcare provider
Before having a stem cell transplant, it's important to discuss this procedure with your healthcare provider. This can help you to understand the possible risks and benefits. A stem cell transplant is a complex procedure. It’s only done by healthcare providers with special training. If you decide to have one, go to a hospital that specializes in stem cell transplants, such as a major cancer center. The procedure is also expensive. Make sure to check with your insurance provider to see how much of it will be covered.
March 21, 2017
Overview of the Management of Multiple Myeloma. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD