Multiple myeloma is a cancer impacting plasma cells in the bone marrow, causing them to grow and divide rapidly. These cancerous cells crowd out healthy blood cells, leading to symptoms like bone pain, fatigue, and weight loss.
A stem cell transplant is one potential treatment for multiple myeloma. It works to replace harmful cells with healthy stem cells that can develop into various types of blood cells, such as:
- red blood cells, which are blood cells that carry oxygen throughout your body
- white blood cells, which are immune cells that are important for responding to infections
- platelets, which work to help your blood clot
In a stem cell transplant, a high dose of chemotherapy is used to kill the cells in the bone marrow, including the cancer cells. Healthy stem cells are then transplanted. These can either come from you (autologous) or a donor (allogenic).
While receiving a stem cell transplant can cause multiple myeloma to go into remission, it isn’t a cure. This means it can come back in the future.
Keep reading to learn more about the effectiveness of stem cell transplants for multiple myeloma, what the procedure is like, and more.
Survival rates for cancer, including multiple myeloma, are often measured as a 5-year relative survival rate. This is the percentage of people with multiple myeloma who are still alive after 5 years.
According to data from the
Stem cell transplants are a commonly used early in treatment for eligible individuals. The 5-year relative survival rates following a stem cell transplant have also improved over time.
For example, a 2020 study found that the estimated 5-year relative survival rate for stem cell transplants received in 2014 or later was 68 percent, compared to a 5-year relative survival rate of 29 percent for stem cell transplants received in 1997 or earlier.
However, it’s important to know that while a stem cell transplant can cause multiple myeloma to go into remission for a period of time, most people eventually relapse. That means that the cancer comes back.
A relapse can happen any time after a stem cell transplant. For many people, it may be years. However, for some, it may be 18 months or less. It’s possible to receive a second stem cell transplant after relapse if you’re still eligible for one.
Nevertheless, stem cell transplants remain an important part of multiple myeloma treatment for eligible individuals. Research has found that having an autologous stem cell transplant can improve overall survival by a
Undergoing a stem cell transplant can be very demanding on your body. Because of this, some individuals may not be a good candidate for this type of treatment.
Generally speaking, good candidates for a stem cell transplant are younger. According to the NCI, this typically breaks down as:
- Younger than age 65: typically considered a good candidate for a stem cell transplant
- Between the ages of 65 and 75: may be eligible for a stem cell transplant, depending on factors like overall health and extent of cancer
- Over age 75: usually not eligible for a stem cell transplant
In addition to age, other factors that can affect your eligibility for a stem cell transplant include:
- your overall health, particularly whether or not you have other serious health conditions
- the stage of your multiple myeloma
- the other treatments you’ve already received
To help assess if you’re a good candidate for a stem cell transplant, your doctor may order a variety of tests to check your overall health and whether your body can cope with the transplant procedure. These may include:
- blood tests to check your blood chemistry and blood count
- imaging tests, such as X-ray, CT scan, or MRI scan
- tests that look at heart function, such as electrocardiogram (EKG) or an echocardiogram
- lung function tests
- screening for chronic viral infections, such as HIV, hepatitis B, or cytomegalovirus (CMV)
Prior to getting a stem cell transplant, you’ll have received other types of treatment for multiple myeloma. This is called induction therapy and is aimed at reducing the amount of cancer cells in your body.
Induction therapy typically lasts a few months and may include treatment like:
After induction therapy has been completed, you’ll then have your stem cell transplant. Let’s explore what that entails in more detail.
Stem cell collection
Two different types of stem cells can be used in a stem cell transplant:
- Autologous. An autologous stem cell transplant uses healthy stem cells that have been collected from your own body.
- Allogenic. An allogenic stem cell transplant uses healthy stem cells that have come from a donor, typically a close family member like a brother or sister. This type of stem cell transplant is typically only done as a part of a clinical trial.
A few days prior to collecting stem cells, growth factors are given. These stimulate the production of stem cells in the body, leading to an increase in the amount of stem cells in the blood.
Collecting stem cells from the blood takes about 3 to 4 hours and involves the following steps:
- An IV is placed in a vein in the arm to temporarily remove blood from the body.
- This blood passes through a special machine that separates out the stem cells.
- After the stem cells have been filtered out, the blood is returned to the body.
- The collected stem cells are frozen until they’re needed for the transplant.
In this step, you receive a high dose of chemotherapy that’s given by using a catheter placed into a vein in your chest called a central venous catheter (CVC). In some cases, radiation therapy is also given during conditioning.
Conditioning works to kills the cells in your bone marrow, including the cancerous cells. It typically takes a week or two.
During conditioning, you may experience unpleasant side effects due to the use of high doses of chemotherapy drugs (and radiation, if it’s used).
Transplanting the stem cells
About a day or two after your conditioning concludes, you’ll receive your stem cell transplant through your CVC. You’ll be awake while this is happening and the transplantation process itself is painless. It typically takes a couple of hours.
These transplanted stem cells can go on to develop into different types of blood cells. In this way, healthy blood-forming cells are restored to your body, while the harmful cancer cells have been removed.
After your stem cell transplant, you’ll receive maintenance therapy. This is a type of treatment that aims to keep your cancer in remission and prevent a relapse from happening.
Some examples of treatments that can be used for maintenance therapy are:
- targeted therapy
- corticosteroid therapy
There are several side effects that you may experience after a stem cell transplant. These can include:
- Chemotherapy or radiation side effects. You may have several temporary side effects due to the high-dose chemotherapy or radiation therapy that’s used during a stem cell transplant. These may include:
- Infusion side effects. It’s possible to have temporary side effects from the stem cell infusion itself, particularly if the cells were frozen down prior to the transplant. These are often mild and may include:
- a strong taste or scent, which is often described as garlicky
- low blood pressure, or hypotension
- Low blood count. Having a low blood count can increase your risk of developing anemia, getting potentially serious infections, or experiencing dangerous bleeding events.
- Graft-versus-host disease. This is a very serious side effect of allogenic transplants. Graft-versus-host disease happens when immune cells from the donor see your own cells are foreign and begin attacking them.
Longer-term side effects
It’s also possible to have some longer-term side effects from a stem cell transplant. These may show up a year or more after your procedure and can include:
You’ll typically stay in the hospital for several weeks to recover from your stem cell transplant. Sometimes, stem cell transplants can be done as an outpatient procedure, but you’ll still need to visit the hospital each day for several weeks to receive follow-up care.
During your recovery period, the transplanted cells settle in and begin developing into new blood cells. This is called engraftment. Your doctor and care team will also monitor you for any signs of serious side effects.
Recovery can involve things like:
- Transfusions. You’ll have low levels of red blood cells and platelets after your transplant, so blood and platelet transfusions can provide you with these vital blood cells as you recover.
- Antimicrobial medications. Low levels of white blood cells after your transplant mean you’ll be more prone to infections. Because of this, you may be given antimicrobial medications like antibiotics or antifungals for a short time.
- Isolation. If you’re in the hospital, you’ll be placed in a special germ-free room. Additionally, any visitors you have during this time will need to wear protective clothing.
- Other medications. You may also be given medications to ease side effects from the conditioning process, such as nausea and mouth sores.
- Blood tests. Blood tests to assess your blood count and blood chemistry can help to inform your doctor about your recovery is progressing.
It can take anywhere between 6 to 12 months for your blood counts to return to normal and for your immune system to fully recover. Because of this, you’ll be more vulnerable to infections, even after you return home.
After you’ve been diagnosed with multiple myeloma, your doctor will meet with you to go over your potential treatment options. A stem cell transplant may be one of these options.
It’s possible that you may have many questions about having stem cell transplant, such as:
- Am I eligible for a stem cell transplant?
- What additional tests need to be done to help determine my eligibility?
- What does the transplant process entail?
- How will having a stem cell transplant affect me both physically and emotionally?
- What types of short-term or long-term side effects are possible and what are ways to cope with them?
- How will having a stem cell transplant affect my prognosis?
- What’s the potential risk of relapse?
- If a relapse happens, how does this affect my treatment plan?
Your doctor and care team are important partners in your treatment journey. If you have any questions or concerns about having a stem cell transplant for multiple myeloma, don’t hesitate to voice them.
Getting a diagnosis of multiple myeloma and choosing to undergo a stem cell transplant can be overwhelming at times. Try not to hold these feelings in and remember that you family, friends, and care team are here to support you.
Stem cell transplants often happen early in treatment, so it may be helpful to view it as the initial steps on your treatment journey. Also, remember that newer, more effective treatment methods are constantly being developed for all types of cancers.
As your proceed with your treatment, remember that every person is different. A variety of factors, including but not limited to, age, overall health, and the stage of a cancer can all work together to influence outlook.
A stem cell transplant is a treatment option for some people with multiple myeloma. It can be effective at improving overall survival, but relapses can often occur after a period of time.
A high dose of chemotherapy is used to kill the cells in your bone marrow, including the cancer cells. You’re then given a transplant of stem cells that have been isolated from the blood prior to your transplant.
These new stem cells will eventually grow and develop into new, healthy blood cells. It can often take several months for your blood count to return to normal.
Stem cell transplants are hard on the body, so not everyone is a good candidate to receive one. If you’ve recently been diagnosed with multiple myeloma, talk to your doctor to see if a stem cell transplant is an appropriate treatment option for you.