Multiple Myeloma: Stem Cell Transplant

A stem cell transplant is a type of treatment your healthcare provider may recommend to treat your multiple myeloma. Stem cells are immature cells that are the starter cells for all types of blood cells. Blood cells are made in the bone marrow located inside bones. A stem cell transplant uses healthy stem cells to replace bone marrow that contains cancer. This process used to be called a bone marrow transplant.

To do a stem cell transplant, high-dose chemotherapy is used to destroy the unhealthy bone marrow. Healthy stem cells are then put in your body. With time, these stem cells will grow and become new and healthy bone marrow cells, which can then make new mature blood cells.

A stem cell transplant is a complex and intense treatment that's hard on the body. It's often part of the treatment plan for multiple myeloma if a person is healthy enough to tolerate it. While a stem cell transplant does not cure multiple myeloma, it can help people live longer.

A stem cell transplant is most often done after the first course of treatment to lower the number of myeloma cells in the body. This treatment might include targeted therapy, chemotherapy, immunotherapy, and other medicines.

Some healthcare providers may recommend that people get 2 autologous stem cell transplants, usually within 6 months of the first course of treatment and stem cell transplant. This is called a tandem transplant. It can help some people live longer, but it can also cause more side effects.

There are two main kinds of stem cell transplants:

• Autologous transplant. This means the stem cells are collected from your own body and frozen. This is done before you get high-dose chemotherapy.

• Allogeneic transplant. These stem cells come from another person (a donor) whose cell type is a lot like yours. This may be a brother or sister.

For multiple myeloma, autologous transplants are preferred. These transplants tend to have fewer side effects and risks. So far, it hasn't been shown that allogeneic transplants work any better. And they're usually done in clinical trials.

Stem cells may be collected in a couple of ways.

Your stem cell transplant is only done at special centers trained to provide this treatment. You may be admitted to the hospital before your transplant. Or it might be done in an outpatient treatment center. Your healthcare provider will go over safety precautions, like how to prepare your food after the transplant, hygiene, and ways to help you prevent germs. You need to do this to lower your risk of infections.

A day or two after the high-dose chemotherapy is done, you’ll get the stored stem cells. They go into your blood just like an IV medicine or a blood transfusion.

You’ll have to wait for the stem cells to travel to your bone marrow in your bones and start multiplying (also called engraftment). You may have to limit your time around people to prevent getting an infection. During this time, you're waiting for part of your white blood cell count (the absolute neutrophil count, or ANC) to get to a safe level. This may happen within a few 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 or months. You may need blood or platelet transfusions until your stem cells start working. You may also be given certain medicines to help prevent infection while you wait for your blood cell counts to go up.

Most of the short-term side effects of a stem cell transplant are from the high doses of chemotherapy. These should go away as you recover. Common side effects can include:

• Infections

• Low blood cell counts

• Bleeding

• Low blood pressure

• Shortness of breath

• Chest pain or tightness

• Coughing

• Fever or chills

• Hair loss

• Nausea

• Vomiting

• Mouth sores

• Loss of appetite

• Diarrhea

• Fatigue (tiredness)

• Weakness

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 a lack of blood supply (aseptic necrosis).

• Growth of another cancer

• Lung problems

• Damage to other organs. These can include your heart, kidneys, or liver.

• Lack of menstrual periods. This may mean ovary damage and 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 (GVHD). This only happens with an allogeneic transplant. It's caused by immune system cells from the donor attacking your body. GVHD can be acute or chronic. Acute GVHD usually occurs within 100 days after the transplant. It may affect your skin, liver, or GI (gastrointestinal) tract. Chronic GVHD can occur any time after transplant (usually within 2 years). It may affect your skin, mouth, liver, lungs, GI tract, muscles, joints or other organs. GVHD can cause symptoms, such as:

• Skin rashes with itching

• Yellowing of your skin (jaundice)

• Severe diarrhea and cramping

• Nausea and vomiting

• Fatigue (tiredness)

• Muscle aches

A stem cell transplant is a serious medical procedure with many risks and side effects. Before having a stem cell transplant, it's important to discuss the details with your healthcare provider or transplant coordinator. This can help you and your family 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 treatment also costs a lot. Check with your health insurance provider to see how much of it will be covered and how much you will have to pay.

Here are some good sources for more information on stem cell transplant as cancer treatment:

• Be the Match: Transplant Basics
• American Cancer Society: Stem Cell Transplant for Cancer
• Leukemia & Lymphoma Society: Stem Cell Transplantation
• National Cancer Institute: Stem Cell Transplants in Cancer Treatment