Multiple Myeloma Treatment Transplants

The most promising treatment for multiple myeloma is a combination of high dose chemotherapy (HDT) and bone marrow transplantation. Although not a cure, the combined treatments produce longer remission periods than conventional chemotherapy. Survival rates have been greatly increased by HDT and bone marrow transplants, with patients surviving as long as 64 months following treatment.

A bone marrow transplant is not effective in all multiple myeloma patients. The cancer may be too advanced or too aggressive for the treatment to be effective. Age also plays a role: bone marrow transplant is recommended only for patients younger than 65 who are in reasonably good health.

High Dose Chemotherapy

High dose therapy, or HDT, is used to kill as much of the cancer as possible before the bone marrow transplant. Melphalan, an anti-tumor drug that prevents cell growth, is typically the chemotherapy drug of choice. Both cancerous and healthy tissue in the bone marrow (and throughout the body) are damaged by chemotherapy. Occasionally, HDT may be combined with radiation therapy to further suppress the cancer.

What are Stem Cells?

Stem cells form in the bone marrow. They are the prototypes from which all types of blood cells form. Without an adequate supply of healthy stem cells, people are at greater risk of infection and bleeding disorders.

High dose therapy is an aggressive treatment and requires that the patient be in relatively good health. Treatment-related mortality can, and does, occur: toxicity rates caused by high dose melphalan may run as high as fourteen percent.

Autologous Stem Cell Transplant

Once HDT treatment is complete the bone marrow has few stem cells left to replenish the body’s blood count. These can be replaced through an autologous stem cell transplant (auto-SCT).

Autologous means that the cells are collected from the patient, and not a donor. The cells are collected prior to HDT therapy. The collection of stem cells originally involved directly accessing the bone marrow, a complicated and invasive operation. In the 1980s, collecting peripheral stem cells from the bloodstream became possible, making stem cell “harvesting” much easier on the patient. Once collected, the cells are cryopreserved (frozen) until the patient is ready for the transplant.

After high dose therapy, the stem cells are thawed, and injected back into the bloodstream, a procedure called re-infusion. Re-infusion takes between two to four hours. During the few weeks following transplantation, the reintroduced cells return to the bone marrow where they develop into healthy blood cells.

The Recovery Period: Avoiding Infection

Immediately following the transplant, the individual is at a heightened risk of infection due to the lack of healthy white blood cells, or leukocytes in the bloodstream. Blood clotting difficulties and severe bleeding may occur. Until the transplanted cells have a chance to replenish the blood count, the risk of these complications must be minimized. Blood cell production can take two to three weeks to restart, and several months before the blood count returns to normal.

During the first two to three weeks of recovery, the patient may receive blood transfusions to prevent bleeding problems and anemia. Preventive antibiotics may be prescribed to reduce the risk of infection. The hospital room is kept as clean as possible: gifts of flowers and other items are not recommended as they may harbor infectious bacteria. For the same reason, the time that hospital visitors they can spend with the patient may be restricted. Full recovery may take two to four months.

Resources

Beers, M. H.,