One potential treatment for multiple myeloma is a stem cell transplant. This involves a person receiving high-dose chemotherapy to kill the cancer cells in the bone marrow. This can also kill healthy cells inside the bone marrow, so the person then receives new, healthy, blood-forming stem cells via a transplant.
The healthy stem cells that a medical professional transplants into a person can come from the person themselves or from a donor. If the stem cells come from the person it is called an autologous transplant. If they come from or a donor it is called an allogeneic transplant.
A stem cell transplant (SCT) may cause multiple myeloma to go into remission, but medical professionals do not consider it to be a cure.
This article looks at types of SCTs, who should have one, what to expect from the procedure, and side effects. It also looks at how effective SCTs are, the recovery and outlook, and alternatives.
There are two types of SCT that people can receive for multiple myeloma:
In an autologous transplant, a doctor removes a person’s own stem cells from their bone marrow or peripheral blood. They then store the cells until they need them for the procedure.
A doctor will give the person high-dose chemotherapy, sometimes with radiation, to kill the cancer cells. The doctor will then give the stored, healthy stem cells to the person through a catheter, similar to a blood transfusion.
This treatment is common for people with multiple myeloma. The cancer often returns, so the procedure is not a cure, but it can make a person’s cancer go into remission for a period of time that may last a number of years.
Doctors sometimes recommend that a person has two autologous transplants. These will often take place 6–12 months apart. This is called a tandem transplant. Research shows that this approach can be more effective than a single transplant. However, a tandem transplant can cause more side effects and may be riskier.
In an allogeneic transplant, a person receives blood-forming stem cells from a donor.
A person will experience the best results if they are given cells that closely match their own type. For this reason, the best donors are often closely related to the person.
Allogeneic transplants carry a higher risk than autologous transplants. However, some studies suggest they may provide better results. This is because the transplanted cells from the donor may actually help destroy myeloma cells. This is called a graft tumor effect.
Studies have shown that people who receive allogeneic transplants may not do as well as those who receive autologous transplants in the short term. Allogeneic transplants are not considered a standard treatment for multiple myeloma, however, medical professionals may give them as part of a clinical trial.
People who are young and are in the early stages of cancer, as well as those who have not already gone through much treatment, often handle STCs better. For this reason, some transplant centers set age limits. This may not be especially helpful to people with multiple myeloma, who are on average 65 years old at diagnosis.
People with other major health issues may not be eligible for STCs. These can include:
- lung disease
- kidney disease
- heart disease
A doctor is likely to perform a variety of tests on the person first, to see if they will be able to handle the process of an STC. These may include:
- a full health history and physical examination
- HLA tissue typing, which is a blood test
- an evaluation of the person’s emotional and psychological strength
- bone marrow biopsy
- heart tests, such as an electrocardiogram (EKG)
- chest x-ray
A doctor is also likely to discuss the related costs a person might incur and the scope of their health insurance coverage. STCs can be expensive, and may cost between
Medicare covers part of the costs of two types of FDA-approved stem cell therapy, or transplants. These types are allogeneic hematopoietic stem cell transplantation (Allo-SCT) and autologous stem cell transplantation (Au-SCT).
The transplant team at the hospital will decide if the person needs to have the transplant in the hospital or in an outpatient center. If the person needs to be in hospital, they may have to start their stay the day before any chemotherapy or radiation treatment begins.
Conditioning treatment is also known as bone marrow preparation, pre-transplant treatment, or myeloablation. It usually involves a doctor giving the person high-dose chemotherapy treatment, radiation treatment, or both. This treatment usually takes 1–2 weeks.
Conditioning takes place for several reasons. These include:
- to suppress the person’s immune system which lessens the chance of their body rejecting the stem cells
- to make room in the bone marrow for the new cells being transplanted
- to destroy remaining cancer cells in the body
Conditioning treatment will be different for each person, and depends on their cancer, any radiation, or chemotherapy treatment they have had in the past, and the type of transplant they are having.
This phase of the treatment can be difficult and uncomfortable, as doctors will use high doses of chemotherapy and radiation. It can make people feel very ill, and it may take months for them to recover.
Side effects of the preparation treatment can include:
- mouth sores
- hair loss
- inability to eat
- nausea and vomiting
- lung or breathing problems
- premature menopause
Infusion of stem cells
After the conditioning treatment, a doctor will give a person a couple of days to rest before giving them the new stem cells.
A doctor will give the stem cells through a central venous catheter, similar to a blood transfusion. The doctor may also give the person drugs to reduce the risk of a reaction to preservatives in the stem cells, if they are using previously frozen stem cells.
The length of the process depends on how much liquid the stem cells are in. This part of the process is painless, and people are awake for it.
Side effects from the transplant itself are rare, and are usually mild.
The preserving agent used when the stem cells are frozen may cause side effects. These may include a person tasting garlic, and their body smelling different or unpleasant. These side effects last for a few days and then go away.
Other side effects can include:
- low blood pressure
- chills or fever
- shortness of breath
- chest pain
- tightness in the chest
- less urine output
The most serious side effect from an allogeneic transplant is called graft-versus-host disease (GVHD). This occurs when the new immune cells from the donor attack the person’s tissue, as they see it as a harmful foreign body. GVHD can be life-threatening.
A 2019 review reports that SCTs improve the survival rate of people compared with treatment that just involves chemotherapy.
As complementary treatments have improved, SCTs have become increasingly effective at treating certain types of cancer.
A person’s blood count should return to normal in about 2–6 weeks. They should visit the transplant center daily for a number of weeks.
A person may have to take antibiotics to prevent infection while their red and white blood cell count is still low.
People may experience side effects, as well as feelings of anxiety, depression, joy, or anger. People may also require a period of rehabilitation following their STC.
People often feel tired, and experience poor mental and physical health following an STC. Doctors will monitor people carefully during the rehabilitation period. They may suggest daily or weekly blood tests and exams.
People may also require platelet and blood transfusions, antibiotics, and other treatments during rehabilitation.
A person may need to see their transplant team frequently, even daily, for a period that may last between 6–12 months. During this time, they may experience problems including:
- kidney, heart or liver problems
- low thyroid function
- reproductive issues, such as infertility and early menopause
- new cancers
- memory loss
- emotional distress
During what may be a difficult period of rehabilitation and recovery, a person should be in close contact with their transplant team for support.
Types of treatment will depend on the type of cancer the person has, as well as their preferences, and their ability to withstand certain treatments.
The use of medication to destroy cancer cells is called systemic therapy. Doctors give this type of treatment through the bloodstream to reach cancer cells throughout the body.
An oncologist may prescribe systemic therapy for multiple myeloma. Systemic therapy may include:
Multiple myeloma is a cancer that affects the plasma cells in the bone marrow, causing them to grow and divide more than usual. This crowds out healthy cells, causing tumors to form in the bone marrow.
Doctors may treat multiple myeloma with stem cell transplants. This involves killing cancer cells with high-dose chemotherapy or radiation, then giving a person new stem cells. The two types of stem cell transplant are an autologous transplant, using stem cells from the person, or an allogeneic transplant, using donor cells. Autologous transplants are much more common.
People with kidney, heart, and lung problems, or people who have had a lot of cancer treatments previously, may not handle a stem cell transplant well. Young people who have no other illnesses are best suited to a stem cell transplant.
A stem cell transplant can increase a person’s chances of survival, but it is not a cure, and may only send the cancer into remission.
People may experience side effects. The worst side effects are likely to come from the chemotherapy and radiation. Side effects of the actual transfusion are rare and usually mild.
Recovery can take a year or more. People should remain in close contact with their transplant team and go for regular check-ups.
Alternative treatments to stem cell transplants include systemic treatment, which involves taking medication to kill the cancer cells.