A Procedure That Improves Outcome
By Heidi Moawad, MD
Medically reviewed by Doru Paul, MD
Stem cell transplantation for multiple myeloma involves a few sequential phases, beginning with the collection of stem cells, pretransplant medication and radiation, intravenous infusion of the stem cells, and maintenance therapy.
Stem cell transplant improves survival and quality of life in multiple myeloma patients. You can experience side effects during and after the procedure, however, and the cancer can recur years after the procedure. These issues can be effectively monitored and treated.1
This article will discuss the types of stem cell transplants for multiple myeloma, how they are performed, possible side effects, recovery, and survival rates.
Verywell / Michela Buttignol
Types of Stem Cell Transplants
There are several different types of stem cell transplants, but they all have the same fundamental features.2 Stem cells are immature cells that have the potential to develop into mature cells.
Multiple myeloma is a cancer that alters B cells (a type of immune cell also called plasma cells) in ways that are harmful to the body. The effects of this cancer include immune deficiency and interference with the production of other types of blood cells.
The stem cells used in transplants for multiple myeloma are blood cell precursors that are selected because of their potential to develop into mature plasma cells to replace the cancer cells.3
The healthy stem cells are infused into a recipient who has multiple myeloma. The newly transplanted cells are expected to multiply inside the recipient’s body and mature into healthy plasma cells that will take over the job of the cancer cells. Allogeneic transplants (from a donor) also provide immunity to help fight the cancer cells.4
The types of stem cell transplants are:
Autologous stem cell transplant: This type of transplant uses stem cells from a person’s own body.5
Allogeneic stem cell transplant: This type of transplant uses stem cells from a donor who does not have multiple myeloma.4 Ideally, the donor is related to the recipient, but if there is no suitable related donor, stem cells from an unrelated donor are used.
Tandem transplants: This is a process in which a person has multiple consecutive stem cell transplants to increase the likelihood of transplant success. Usually, the subsequent stem cell transplant is scheduled between six to 12 months after the first one.2
Mini transplants: This type of allogeneic transplant uses lower-dose radiation and less toxic chemotherapy to reduce the risk of allogeneic stem cell transplant–associated complications.6
Syngeneic transplants: This is a stem cell transplant in which the donor is the identical twin of the recipient. Syngeneic transplants can lower the risk of a recipient receiving stem cells that will become cancer cells (this is a risk of autologous transplants) while reducing the risk of rejection and graft-versus-host disease (risks of allogeneic transplants).3 However, since most people do not have an identical twin, a syngeneic transplant is rarely possible.
For treatment of multiple myeloma, autologous tandem transplants are the most common types preferred to improve treatment success.2
How Does a Stem Cell Transplant Work?
This procedure involves several steps to increase the chances of treatment success and cancer cure, including:
Stem cell collection: The stem cells are typically collected from the blood, and sometimes from the bone marrow. These cells are collected from a donor before an allogeneic stem cell transplant, and from the recipient before an autologous transplant. Then the cells are frozen until the transplantation takes place.
Conditioning/cancer treatment: This pretransplant process includes chemotherapy and radiation.6 These treatments kill the body’s cancer cells in preparation for the transplant. Induction is also given, which is an immune-modifying treatment to help prevent the recipient’s immune system from fighting against the transplanted cells.7
Stem cell transplantation: This process involves intravenous infusion of the stem cells. You may have a central line, which is a large intravenous line, placed with a minor surgical procedure for the infusion. The infusion will take several hours, and your blood pressure, oxygen level, pulse, and breathing rate will be monitored during the process.
Maintenance therapy: After your transplant, you may need chemotherapy treatment to prevent your cancer from recurring. Different chemotherapy medications have their own side effects, and your medical team will discuss the side effects of your specific maintenance treatment with you.
The whole process before your maintenance therapy is started can take weeks or longer. You may have side effects from conditioning and induction, and these side effects can decrease when you have your transplant.
Side Effects of Stem Cell Transplantation
You can experience short-term and long-term side effects from your stem cell transplant. Your medical team will monitor you to identify early signs. Additionally, it’s important for you to be aware of the potential side effects so you can get medical attention if you start to develop any of them:
Chemotherapy and radiation side effects: The side effects of these treatments can vary, and may include nausea, vomiting, skin fragility, hair loss, fatigue, and infections.7
Infusion side effects: During or shortly after your infusion you may feel light-headed, dizzy, nauseated, or short of breath. Tell your medical team if you experience any side effects during or after your infusion. You might need treatment for your side effects during your infusion.
Low blood count: Sometimes the induction or conditioning treatment can lower your red blood cells or white blood cells. This may cause symptoms such as light-headedness, fatigue, or infections, Sometimes blood count changes can be detected with blood tests even if you don't have symptoms.
Graft-versus-host disease: Transplanted donor cells may attack the recipient's tissue. The acute form can cause a rash, fevers, and organ damage. The chronic form may cause fatigue and organ damage. These conditions can be treated with medication. Your medical team will regularly monitor you for signs of graft-versus-host disease.
Long-term side effects: Sometimes the medications used before and after this procedure can cause long-term health issues, including infertility, hormone problems, and an increased risk of developing another type of cancer.
Effectiveness and Survival Rates
This treatment is associated with cure rates ranging from 6.3% to 31.3%, with improving cure rates in recent years. Additionally, 10%–18.6% of patients who have had this treatment achieve their normal life expectancy. In one study, after three years of follow-up, almost 72% of patients had not experienced progression of multiple myeloma.8
Sometimes multiple myeloma recurs after stem cell transplant, and a second transplant can be used to treat recurrence. The median time before a second transplant is 4.5 years, and it is found to have a good survival rate.1
Recovery and Preventing New Infections
After stem cell transplant, you would be at risk of infection for at least a few weeks. During this time, you would need to avoid exposure to people who have any type of contagious infection. Additionally, you would need to avoid exposure to infections that can come from food, swimming, or plants.
Your medical team will provide you with detailed instructions regarding which foods you can eat. You might also be prescribed antibiotics to prevent or treat infections.
Monitoring
While you are recovering, you may have blood tests to assess your blood cells and the early effects of your transplant.
Am I a Good Candidate?
This procedure can be done at early or late stages of multiple myeloma. You might be a candidate if your health would allow you to tolerate the conditioning regimen and if you are able to accept the recovery time.5
Sometimes there are age limits for stem cell transplantation due to the risks associated with this treatment.
Summary
Stem cell transplant is an option for treatment of multiple myeloma. This procedure uses immature blood cells (from the recipient themselves or from a donor) to replace the cancer cells. The process involves pretreatment induction and conditioning to reduce the prevalence of cancer cells before the transplant is infused.
Then, maintenance therapy may be needed to prevent the cancer from recurring. There are side effects, including graft-versus-host disease if donor cells are used, but the procedure is associated with prevention of disease progression and improved survival, and sometimes it is curative.
Sources
Galligan D, Williamson S, Myers J, Silbermann R, Medvedova E, Nagle S, Schachter L, Chen A, Scott E, Maziarz R. Second autologous stem cell transplant as salvage in multiple myeloma - The Oregon Health and Science University experience. Clin Lymphoma Myeloma Leuk. 2021 Sep 14:S2152-2650(21)00366-9. doi:10.1016/j.clml.2021.08.008
American Cancer Society. Stem cell transplant for multiple myeloma. February 28, 2018.
Lebel E, Prica A, Bhella S, Kukreti V, Tiedemann R, Trudel S, Reece D, Chen C. Syngeneic transplants for multiple myeloma - a single center experience and review of the literature. Leuk Lymphoma. 2020 Dec;61(14):3519-3522. doi:10.1080/10428194.2020.1817443
Khorochkov A, Prieto J, Singh KB, Nnadozie MC, Shrestha N, Dominic JL, Abdal M, Abe RAM, Masroor A, Mohammed L. The role of allogeneic stem cell transplantation in multiple myeloma: A systematic review of the literature. Cureus. 2021 Sep 27;13(9):e18334. doi:10.7759/cureus.18334
Devarakonda S, Efebera Y, Sharma N. Role of stem cell transplantation in multiple myeloma. Cancers (Basel). 2021 Feb 18;13(4):863. doi:10.3390/cancers13040863
Lorenzo Iovino, Enrico Orciuolo, Gabriele Buda, Francesco Caracciolo, Francesco Mazziotta, Sara Galimberti, Mario Petrini, Edoardo Benedetti; Mini-allogeneic transplantation in multiple myeloma: A single-center ten-year experience. Blood 2014; 124 (21): 5928. doi:10.1182/blood.V124.21.5928.5928
Gaballa MR, Ma J, Tanner MR, Al-Juhaishi T, et. al. Real-world long-term outcomes in multiple myeloma with VRD induction, Mel200-conditioned auto-HCT, and lenalidomide maintenance. Leuk Lymphoma. 2021 Oct 22:1-12. doi:10.1080/10428194.2021.1992763
Nishimura KK, Barlogie B, van Rhee F, Zangari M, Walker BA, Rosenthal A, Schinke C, Thanendrarajan S, Davies FE, Hoering A, Morgan GJ. Long-term outcomes after autologous stem cell transplantation for multiple myeloma. Blood Adv. 2020 Jan 28;4(2):422-431. doi:10.1182/bloodadvances.2019000524
By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.
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