Autologous stem cell transplantation (ASCT) is a popular treatment option for eligible individuals with multiple myeloma. It can allow people with multiple myeloma to grow healthy blood cells again. However, ASCT can cause some severe side effects.

Some people refer to autologous transplantation as “autotransplantation.” However, autotransplantation more commonly refers to physical organ transplants. Autologous stem cell transplantation is a standard form of treatment for multiple myeloma (MM).

MM is a type of cancer that affects the formation of blood cells within the bone marrow.

This article will explain the nature of ASCT and its relevance to MM and compare it with a different form of stem cell transplantation. It will then look at the success rate, side effects, and results of ASCT.

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A person’s stem cells, or blood-forming cells, lie within their bone marrow and blood. As the National Cancer Institute explains, ASCT is a procedure in which doctors remove healthy stem cells from an individual’s bone marrow or peripheral blood. Doctors carry out this process before beginning an aggressive form of treatment, such as chemotherapy or radiation therapy.

If this treatment damages the remaining healthy stem cells, doctors will reintroduce the previously removed stem cells through a vein. This should help the bone marrow make healthy blood cells again. ASCT is the preferred and standard treatment for people with MM who meet the criteria.

As MM is a type of cancer that affects the bone marrow, ASCT can be very helpful. A 2021 medical review explains that MM occurs when plasma cells begin to develop in an uncontrolled fashion. This often requires radiation therapy or chemotherapy, which aim to kill those cancerous plasma cells.

Learn more about MM treatment here.

A 2021 article explains that ASCT remains a common form of MM treatment, at least in people who are under 65 years of age.

When someone with MM uses ASCT alongside other forms of medication, they can improve their overall chances of survival and lower the odds of disease progression.

The American Cancer Society (ACS) explains that there are two types of stem cell transplantation:

  • Autologous stem cell transplantation: This type uses stem cells from the person who receives the transplant. It is a standard treatment for MM.
  • Allogeneic stem cell transplantation: This type uses stem cells from someone else. It is only available for MM through clinical trials.

Effectiveness

Neither form of transplant is guaranteed to succeed.

Autologous transplants can keep a person with MM in remission for a long time — possibly even years. However, it is not a curative treatment, and the MM often returns.

As autologous transplants use a person’s own stem cells, the body is less likely to reject the transplanted or “grafted” stem cells when compared with allogeneic stem cell transplantation. On the other hand, autologous transplantation can reintroduce cancerous stem cells into the bone marrow, as doctors take these cells from people who have not yet received cancer treatment.

Both forms of stem cell transplantation carry risks and benefits. Nevertheless, it is unusual for doctors to recommend allogeneic stem cell transplantation for MM, although a person may wish to participate in clinical trials for this treatment.

Learn more about different types of stem cell transplants here.

Since doctors administer ASCT alongside other forms of medication, which may vary from person to person, it is difficult to determine its success rate.

A 2021 review states that in a 2003 study, the average participant with MM survived about 4.5 years when doctors supplemented high dose treatment with ASCT. By comparison, the average participant with MM survived 3.5 years if their high dose treatment did not include ASCT.

A 2020 review found that the 5-year survival rate of people with MM after ASCT was 63%.

The survival rate refers to the proportion of people who are still alive for a length of time after receiving a particular diagnosis. For example, a 5-year survival rate of 50% means that 50%, or half, of the people are still alive 5 years after receiving the diagnosis.

It is important to remember that these figures are estimates and are based on the results of previous studies or treatments. A person can consult a healthcare professional about how their condition is going to affect them.

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Scientists also know that various other factors can affect the success of ASCT. For instance, a 2018 study investigated the use of ASCT in 13,494 Californians with MM. It found that individuals who received ASCT within 12 months of their MM diagnosis were more likely to survive for a longer period than those who received the same treatment at a later point.

Learn about the different stages of MM here.

A 2021 article explains that to perform an ASCT, doctors must remove close to 1.5 liters of bone marrow, often by aspirating about 15 milliliters at a time. Aspiration requires doctors to insert a syringe into a person’s bone while they are under local or general anesthesia. Doctors generally remove the bone marrow from a person’s pelvis.

Complications occur in less than 1% of procedures.

After the bone marrow aspiration, doctors can proceed to treat the MM itself. When the individual recovers from the treatment, doctors can reintroduce the removed stem cells to their body. This occurs via an infusion, which may take up to 2 hours.

As the ACS explains, the most severe side effect of ASCT may be a low blood count, which can raise a person’s risk of bleeding and infections.

ASCT can also lead to side effects similar to those of chemotherapy and radiation, though they may be more severe. These include:

There is also evidence that in people who are over 74 years of age, ASCT can cause:

As a 2019 review explains, ASCT does not definitively cure MM. This means there is always a chance the MM will come back, even when the ASCT was initially effective.

Although scientists are unsure how quickly such relapses can occur after treatment, there is evidence that 16% of people with MM will relapse around 8 months after their treatment ends.

The overall outlook for people with MM varies from person to person and relates to how well they respond to treatment.

Certain forms of treatment can greatly improve life expectancy. For example, a 2019 study notes that combining ASCT with lenalidomide drug therapy can reduce the fatality rate of the condition by 25% and improve life expectancy by an average of 2.4 years.

MM is nonetheless a serious condition, with symptoms and treatments that can be very challenging.

Learn more about the outlook for people with MM.

A person may wish to discuss the pros and cons of ASCT with their doctor before deciding to undergo this treatment.

Pros

  • ASCT means the body is less likely to reject grafted stem cells.
  • It can improve the life expectancy of people with MM.
  • It helps the body recover from aggressive cancer treatments.

Cons

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ASCT involves taking stem cells from a person’s bone marrow. Doctors may choose to do this before a person undergoes an aggressive form of treatment, so they can reintroduce the healthy stem cells afterward to help the body recover.

Multiple myeloma affects the bone marrow, so stem cell transplantation can be especially helpful in bolstering the body’s production of healthy blood cells.

However, as with any form of cancer treatment, ASCT can have significant adverse effects. Scientists will continue in their attempts to improve the efficacy and tolerability of ASCT for people with MM.