Stem cell transplant for multiple myeloma

Some people with multiple myeloma will have a stem cell transplant. Stem cells are found in the bone marrow, the bloodstream and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. All our blood cells develop from blood stem cells.

The first step of a stem cell transplant is to get high-dose chemotherapy to kill all of the cells in the bone marrow, including the myeloma cells. The next step is to get healthy stem cells to replace the ones in the bone marrow destroyed by the chemotherapy.

You may be offered a stem cell transplant to treat multiple myeloma:

• after induction therapy
• if the disease has come back after it has been treated (called relapse) or treatment is no longer working (called refractory treatment)

Your doctor will base the decision of whether or not to do a stem cell transplant on your age, your general health and the results of organ function tests. Organ function tests look at how well your organs, such as the liver, kidneys, heart and lungs, are working. A stem cell transplant is a complex procedure that must be done in specialized transplant centres or hospitals.

The following types of stem cell transplants may be used with multiple myeloma.

In this type of transplant, the stem cells are taken from your own bone marrow or blood after you’ve had induction therapy to kill the myeloma cells. An autologous transplant is usually preferred for multiple myeloma because most people are older than 50 when they are diagnosed.

Sometimes this procedure is repeated a few months following the first transplant. This is called a tandem transplant.

In this type of transplant, the stem cells are taken from one person (the donor) and are given to another person (the recipient). The donor may be a relative or may be unrelated to the recipient. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing. The use of allogeneic stem cell transplant is limited by the need for a matched donor and the side effects, which people over the age of 50 may not be able to tolerate.

Allogeneic stem cell transplants are considered experimental in multiple myeloma and are usually only given in a clinical trial.

The side effects of high doses of chemotherapy used before a stem cell transplant may be too severe for people over 50 years of age. People in this age group may also have other health conditions that mean they can’t have an allogeneic transplant with high-dose chemotherapy. Low doses of chemotherapy drugs are sometimes used so that the transplant can be given to older people. This procedure is called a mini-transplant, non-myeloblative or reduced-intensity transplant. A mini transplant is less toxic than an allogeneic transplant with high-dose chemotherapy.

In this type of transplant, the stem cells are taken from the recipient’s identical twin.

Side effects can happen with any type of treatment for multiple myeloma, but everyone’s experience is different.

Side effects can develop any time during, immediately after or a few days or weeks after a stem cell transplant. Sometimes late side effects develop months or years after a stem cell transplant. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of a stem cell transplant will depend mainly on the type of chemotherapy drug or drug combination given, if radiation therapy was given, the type of transplant and your overall health. Common side effects of a stem cell transplant include:

• infection
• bleeding
• anemia
• graft-versus-host disease
• veno-occlusive disease
• digestive system problems, such as sore mouth, nausea and vomiting
• skin and hair problems
• pain

Tell your healthcare team if you have these side effects or others you think might be from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about stem cell transplant and side effects of stem cell transplant. To make the decisions that are right for you, ask your healthcare team questions about stem cell transplant.