Stem Cell Transplant for Multiple Myeloma

A stem cell transplant (SCT) is a common treatment for multiple myeloma, especially in people who are younger and otherwise fairly healthy. It can often help people live longer and keep the myeloma in remission longer than if they get just get drug treatments alone.

What is a stem cell transplant?

In a stem cell transplant, a person gets high-dose chemotherapy to kill the cells in their bone marrow. (Bone marrow is where new blood cells are made, including myeloma cells.) After this chemotherapy, the person is given an infusion of new, healthy blood-forming stem cells to replace the ones that were killed.

When stem cell transplants were first developed decades ago, the new stem cells were taken from the bone marrow, so this was known as a bone marrow transplant (BMT). Now, stem cells are more often collected from blood. This is known as a peripheral blood stem cell transplant (PBSCT).

Compared to bone marrow transplants, PBSCTs are likely to start working faster. Stem cells are also less likely to be contaminated with myeloma cells.

Who can get a stem cell transplant?

There aren't strict criteria for who can get a stem cell transplant. But in general, a person might be able to get a stem cell transplant if they:

• Are in fairly good health
• Can do most daily activities on their own
• Don't have serious liver or heart disease

When might a stem cell transplant be done for multiple myeloma?

People usually get at least several months of treatment with different medicines before having a stem cell transplant (SCT). This can help lower the number of myeloma cells in the bone marrow and blood, help relieve symptoms, and help organs recover from damage the myeloma might have done.

• Early SCT: Some people get a stem cell transplant after these first few months of treatment with medicines.
• Late or delayed SCT: Some people continue to be treated with medicines and wait until their myeloma progresses before getting a transplant.

In general, early stem cell transplants are more likely to be helpful in the short term, although it's not clear that they help people live longer compared to delayed transplants.

Your cancer care team will take several factors into account when deciding between an early or a delayed SCT, including your preferences.

For some people, doctors might favor one approach over the other. For example, doctors often advise an early transplant if the myeloma is 'high risk' (because of certain gene or chromosome changes in the myeloma cells) or if a person is older.

Autologous stem cell transplant for multiple myeloma

The type of stem cell treatment (SCT) used to treat multiple myeloma is known as an autologous SCT.

For this treatment, your own blood stem cells are removed before treatment and then given back to you later to rebuild your bone marrow. This is different from an allogeneic SCT, in which the stem cells come from someone else.

What to expect during an autologous stem cell transplant

Before you have an autologous SCT, your own stem cells are removed from your bone marrow or peripheral blood. These cells are frozen and stored until they are needed for the transplant.

At the time of the transplant, you will get high-dose chemotherapy (typically with the drug melphalan) to kill the myeloma cells. When this is complete, your stored stem cells are given back to you as an infusion into your blood through a vein. The stem cells travel to your bone marrow and start making new blood cells.

Although an autologous transplant can make the myeloma go away for a time (even years), it's very unlikely to cure it.

Tandem transplant (double transplant)

Some doctors might recommend that certain people with multiple myeloma get 2 autologous transplants, typically 3 to 6 months apart. This approach is called a tandem transplant or double transplant.

This may help some people more than a single transplant, especially if the myeloma is 'high risk' (because of certain gene or chromosome changes in the myeloma cells). A drawback of this approach is that it causes more side effects and as a result can be riskier.

Maintenance therapy after a stem cell transplant

A few months after a stem cell transplant, people usually start getting maintenance therapy (most often with lenalidomide, either alone or combined with another drug).

Side effects of stem cell transplants

The early side effects from a stem cell transplant (SCT) are similar to those from chemotherapy, although they may be more severe because of the high doses used. One of the most serious side effects is low blood counts, which can lead to risks of serious infections and bleeding.