Stem cell transplant for multiple myeloma

A stem cell transplant replaces stem cells. It uses chemotherapy at very high doses to kill all of the cells in the bone marrow. This includes both healthy cells and cancer cells. After high-dose chemotherapy, healthy stem cells are given to replace the ones in the bone marrow that were killed.

Stem cells are found in bone marrow, blood and umbilical cords. They are basic cells that develop into different types of cells that have different jobs. For example, all our blood cells develop from blood stem cells.

This treatment is used to replace stem cells when stem cells or bone marrow or both are damaged. A stem cell transplant is very risky and complex, and it must be done in a special transplant centre or hospital.

Some people with multiple myeloma will have a stem cell transplant. You may be offered a stem cell transplant to treat multiple myeloma if you meet the criteria set by your treatment centre. This usually means you are 70 years of age or younger and are in generally good health. This is called being transplant eligible or having transplant eligible multiple myeloma.

You may also be offered a stem cell transplant for multiple myeloma if the cancer has come back after it was treated (called relapsed multiple myeloma) and one of the following is true:

• You didn't have a stem cell transplant as a first-line therapy.
• There was a remission following the first stem cell transplant of 4 years or more.

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

In an autologous stem cell transplant, 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 the most common type of stem cell transplant used to treat multiple myeloma.

Some people may choose to wait to have an autologous stem cell transplant until after the first relapse. Your stem cells will still be collected early during first-line therapy as it may be difficult to collect them after you have taken some targeted therapy drugs for a while.

In an allogeneic stem cell transplant, stem cells are taken from one person (the donor) and given to another person (the recipient). The donor and recipient may or may not be related. The donor and recipient are matched through a process called human leukocyte antigen (HLA) typing.

Allogeneic stem cell transplants are not routinely offered and are usually only given in a clinical trial.

Side effects of an autologous stem cell transplant will depend mainly on the type of chemotherapy or drug combination given, the type of transplant and your overall health. Tell your healthcare team if you have side effects that you think are 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.

Side effects of an autologous stem cell transplant include:

• low blood cell counts, which can cause infection, bleeding and anemia
• digestive system problems, including sore mouth and throat, loss of appetite and diarrhea
• skin problems
• organ problems, such as kidney, lung or heart problems
• fertility problems
• second cancers

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