Stem cell transplant for myeloma

You may be offered a stem cell transplant, also known as high-dose therapy and stem cell rescue, to destroy any remaining myeloma cells and increase the length of the plateau phase (remission).

Learn more about:

How it works
Who it is suitable for
Stem cell transplant steps
Side effects of stem cell transplant

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How does it work?

This treatment 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. Find out more about this process below.

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.

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 aggressive it is and how it responds to treatment. Stem cell transplants are available only at some hospitals, so you may need to be referred to another hospital. The haematologist will discuss the risks and benefits of a stem cell transplant with you.

Most people receive their own previously collected stem cells (autologous transplant). Rarely, stem cells from another person are used (allogeneic transplant).

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

Stem cell transplant steps

A general autologous transplant process is described here, but the process varies from person to person. Detailed information is available from the Leukaemia Foundation.

1. Collecting stem cells

The first stage is to collect a supply of stem cells.
If your own stem cells are used, you will usually be given a dose of chemotherapy followed by a special growth factor drug called granulocyte-colony stimulating factor (G-CSF). In some hospitals, you may just have the G-CSF without the chemotherapy.
The growth factor drugs are given for 5-10 days, and will help increase the number of stem cells in the bone marrow. This process of collecting stem cells is called mobilisation and takes several days.
When enough stem cells have been made, 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 cannula.
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).
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 catheter or a central line.
About 24 hours before the transplant, you’ll have high-dose chemotherapy to kill the myeloma cells. This will also destroy the 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 high-dose chemotherapy, your frozen stem cells are thawed and returned to you via a cannula, PICC line, Hickman catheter 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.

Side effects of stem cell transplant

Recovery time after a stem cell transplant varies depending on your situation. Talk to your doctor or nurse about what to expect.

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 your 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.

It takes a while to get over the fatigue, but I can honestly say that I feel more like the person I was pre-myeloma thanks to the transplants. That is something I give thanks for every day.

— Vicki

This information was last reviewed in October 2018. View who reviewed this content.

Dr Jane Estell, Senior Staff Specialist, Haematology Department, Concord Cancer Centre, and Senior Clinical Lecturer, The University of Sydney; Brenda Clasquin, 13 11 20 Consultant, Cancer Council NSW; Jacqui Keogh, Senior Myeloma Support Nurse, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital and Sydney Adventist Hospital; and John Miller, Consumer.

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