Stem Cell Transplantation for Multiple Myeloma

Some research studies have shown that stem cell transplantation offers the best chance of controlling multiple myeloma and helping people live longer. However, it is a rigorous therapy that can cause damage to the internal organs and increase the risk of life-threatening infections. Other studies have suggested with the use of new drugs in combination, similar outcomes may be achieved without the need for stem cell transplant. This is an area of active investigation and should be discussed with your physician.

If you are in good physical condition and have strong heart, lung, and kidney function, your doctor may recommend stem cell transplantation as therapy. This would be done after you have received initial treatment with other anticancer medications, such as the targeted therapies and/or chemotherapy.

A stem cell transplant allows you to receive very high doses of chemotherapy. The high doses destroy both the myeloma cells and normal blood cells in the bone marrow. Later, you receive healthy stem cells through a flexible tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

The transplanted stem cells may come from the patient or a donor:

• Autologous stem cell transplantation - This is the most common type of transplant used to treat multiple myeloma. It uses the patient’s own stem cells. The stem cells are removed from the patient’s bloodstream before high-dose chemotherapy or radiation is given. The cells are treated to kill myeloma cells that may be present, and then they are frozen and stored. After the patient receives high-dose treatment, the stored stem cells are thawed and returned to the bloodstream. They make their way to the bone marrow, where they begin to generate new blood cells.
• Allogeneic stem cell transplantation - Sometimes healthy stem cells from a donor are used. The patient’s brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match the patient’s cells. This type of transplant has a high risk of a complication known as graft-versus-host disease. This occurs when the donor’s immune cells attack the body of the transplant patient because they do not recognize it as their own. Because of this risk, allogeneic stem cell transplants are performed less frequently for people with multiple myeloma. It also can be very difficult to find an appropriate donor.
• Syngeneic stem cell transplantation - This type of transplant uses stem cells from the patient’s healthy identical twin.

Stem cell transplants usually take place in the hospital. Some patients may benefit from more than one stem cell transplant. In fact, researchers are investigating whether two stem cell transplants (called double or tandem transplants) done 6 months apart can offer greater benefit than a single transplant.