Stem cell transplant for myeloma

You may be offered a stem cell transplant where diseased blood cells are destroyed by high-dose chemotherapy and then replaced with blood stem cells. This is also known as high-dose therapy and stem cell rescue.

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How does it work?

This treatment aims to destroy as much as possible any remaining myeloma cells and increase the length of the plateau phase (remission). Your own stem cells are most frequently used for this procedure. This is called an autologous transplant.

Occasionally, stem cells from a donor may be recommended. This is called an allogeneic transplant.

An autologous transplant is done in several stages. Before the process begins, you have induction treatment to put the myeloma into a plateau phase. Once this is achieved, the stem cells are removed and frozen. You then have high-dose chemotherapy followed by the return of your stem cells. See below for a detailed description of this process.

Who is it suitable for?

Although a stem cell transplant can help some people, it is not suitable for everyone. The high-dose chemotherapy that is given before the transplant can have a lot of side effects.

To work out whether a stem cell transplant is suitable for you, your haematologist will consider your general health, age, the type of myeloma you have, how fast it is growing and how it responds to treatment. The haematologist will discuss the risks and benefits of a stem cell transplant with you. Stem cell transplants are available only at some hospitals, so you may need to be referred to another hospital.

The entire procedure, including recovery, can take months and even up to a year.

Stem cell transplant steps

A general autologous transplant process is described here, but the process varies from person to person. Learn more at the Leukaemia Foundation.

1. Collecting stem cells

  • The first step is to collect a supply of stem cells.
  • This process is called mobilisation and may start with a dose of chemotherapy followed by a special growth factor drug called granulocyte-colony stimulating factor (G-CSF). Or you might simply have a course of G-CSF without the chemotherapy.
  • The growth factor drug is given for 5–10 days and will help increase the number of stem cells in the bone marrow, which then enter the bloodstream. This process will take several days.
  • The level of stem cells in the blood will be measured and when adequate numbers are present, they are collected via a process called apheresis.

2. Separating and storing stem cells

  • Apheresis usually involves inserting a needle called a cannula into a vein in each arm. (People with weak veins may need a special line known as an apheresis catheter.)
  • Blood is taken from your body through one of the cannulas and passed through a machine called a cell separator. The stem cells are removed, and the rest of the blood is returned to your body through the other acnnula.
  • This process takes 3–4 hours and may need to be repeated the next day.
  • The stem cells are processed and frozen using liquid nitrogen (cryopreserved).
  • After the stem cells are collected and stored, you will then have a rest period at home for about a month until the next stage of treatment.

3. Receiving high-dose chemotherapy

  • High-dose chemotherapy, often referred to as conditioning therapy, is given through a vein. A long, flexible plastic tube is usually used. This may be a peripherally inserted central catheter (PICC line), a Hickman line or a central line.
  • About 24 hours before the transplant, you’ll have high-dose chemotherapy to kill as many of the myeloma cells as possible. This will also destroy the normal stem cells in the bone marrow. Before and after the chemotherapy is given, you will have fluids through a drip to prevent dehydration and kidney damage.
  • Common side effects from the high- dose chemotherapy include infection, nausea, diarrhoea and mouth sores. Because your stem cells have been destroyed, your blood count will be low and you will be more at risk of infections.

4. Transplanting stem cells and engraftment

  • A day or so after the high-dose chemotherapy, your frozen stem cells are thawed and returned to you via a cannula, PICC line, Hickman line or central line. This process takes about an hour, and you may have side effects, such as nausea and stomach cramps. These can be managed with medicines.
  • Your stem cells will develop into new blood cells, allowing your bone marrow to recover. This is called engraftment and takes about 10–14 days.
  • You will usually stay in hospital for 1–4 weeks, depending on how soon you are well enough to go home.

Some people continue to have drug therapies after a stem cell transplant. This is known as maintenance treatment. It is used to keep myeloma responding to treatment for longer.

Side effects of stem cell transplant

Recovery time after a stem cell transplant varies depending on your situation. After the transplant, your blood count will be low. You may be more at risk of infections and need transfusions of blood products and intravenous antibiotics. You will be able to go home when your blood count has risen and your general health has improved. You will have regular follow-up care to check your blood counts and progress.

Infection, fatigue and diarrhoea are common side effects during engraftment. The diarrhoea usually stops by the time you go home, but the fatigue can last for months or even up to a year.

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This information was last reviewed in September 2020 View who reviewed this content.

Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.

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