A stem cell transplant replaces unhealthy blood cells with healthy ones. It can be a strong weapon in your fight against multiple myeloma.
It’s not a cure, but it can help you feel better and maybe live longer.
When you’re fighting multiple myeloma, you want high-dose cancer treatment. But strong treatment also wipes out your bone marrow, the spongy tissue inside bones where blood cells are made.
A transplant can reboot your marrow so it makes your blood healthy again.
It works well for a lot of people. But transplants aren’t for everyone. If you and your doctors think one is right for you, you should learn your options and what to expect before, during, and after treatment.
What are stem cells?
You may have heard about embryonic stem cells in the news, but stem cells used in cancer treatment are different. They’re called hematopoietic (blood-forming) stem cells. They’re cells in bone marrow that aren’t quite “grown up.”
What’s special about them? They quickly divide to become all the blood cells you need to live:
- Red blood cells, which carry oxygen
- White blood cells, which fight infection
- Platelets, which clot your blood
Once blood cells mature, they leave the marrow and enter your bloodstream.
Can I get a stem cell transplant?
That depends on a few things, including:
- Your stage of disease
- How fast it’s growing
- Which cancer-fighting treatments you’ve already had
Your general health comes into play, too. There are no hard and fast rules. But if you’re otherwise healthy and under age 77, you’ll probably get the OK.
What are the types of transplants?
Autologous transplants use your own healthy stem cells. About half of people with multiple myeloma can have this type of transplant. It’s considered standard care.
It can keep myeloma at bay for a while, even years. But eventually, cancer comes back.
Tandem are back-to-back autologous transplants. You get a round of cancer treatment followed by a transplant. You repeat the process a few months later.
Studies show that this may be more effective than just one transplant for some people. But there could be more side effects with this method than with an autologous transplant.
Allogeneic transplants use stem cells from another person. The donor’s tissue type needs to be a close match to yours to avoid serious side effects. Usually, a brother or sister is a first choice. Unrelated but well-matched donors can be used, too.
Allogeneic transplants are much riskier than autologous ones. But they may fight cancer better. This is because donor cells can kill myeloma cells that survived cancer treatment.
Mini transplants are allogeneic but depend more on the donor cells to zero-in on and kill the cancer cells. As a result, you’d get lower doses of chemo and radiation beforehand. If you are older or have other health problems, this may be a good choice for you.
Syngeneic transplants are allogeneic transplants that come from an identical twin. If you’re lucky enough to have one, this may be your best option because the transplanted cells will be the best match they can be.
What are the steps?
1. Stem cells are collected. In the past, they were taken directly from the marrow in an operation called a bone marrow harvest. Today, most stem cells are collected from the bloodstream.
The donor (that means you or another person) will get a drug that makes cells grow faster and helps them leave the marrow. When enough are in the blood, they’re removed from the donor.
Blood is taken through a tube put into a large vein. It goes through a machine that takes out the stem cells and returns the rest of the blood. Usually, enough are collected for at least two transplants.
The cells are frozen until you’re ready for them.
2. Cancer treatment begins. A doctor will give you high-dose chemo and maybe radiation to kill as many cancer cells as possible. You may get bad mouth sores, diarrhea, or other side effects. Your doctors can give you medicine to help you feel better.
3. Stem cells are transplanted. You’ll get them through an IV. Side effects are usually mild.
The cells will travel to your bone marrow and eventually start to make new blood cells.
Your medical team will take extra steps to protect you from infection because your immune system will take a hit. You may feel very tired because of low blood counts.
You may need:
- Transfusions of red blood cells to fight anemia
- Platelets to stop bleeding
- Antibiotics or other drugs to stop infections
Your blood counts should start to rise within a few weeks. You may hear this called “engraftment.”
What can I expect after the transplant?
If you got an allogeneic transplant, doctors will look for signs that donor cells are attacking your body. This is called “graft-versus-host disease,” and it can happen right away or months later. It can be serious, but it’s usually treatable.
You may go home when your blood counts are high enough to fight infection and prevent bleeding.
But even after you’re home, you’re still on the mend and you’ll be followed closely. It can take 6 months or longer to fully recover from a transplant.
What else should I know?
Deciding whether to get a stem cell transplant isn’t easy. You and your doctor may choose to use other treatments first and do a transplant if you get worse.
Ask your doctor if it makes sense to collect your stem cells early while they’re still in good shape. You might need them in the future.