Is a Stem Cell Transplant Always Needed for Multiple Myeloma Treatment?

RELATED: How Does a Stem Cell Transplant Work?

"In general, we do see stem cell transplants as useful," Dr. Pianko says. "We know that stem cell transplants lengthen the amount of time before a person's myeloma relapses or when it needs a change in treatment."

He adds that there haven't been studies comparing overall survival between patients who have this transplant and those who have other treatments. Dr. Pianko also notes that the best timing of the procedure has yet to be definitively established, and that makes the question of a stem cell transplant's necessity a complicated one to answer. "We have not yet seen that there was a difference in overall survival between patients who have a stem cell transplant as part of their initial set of treatments versus potentially doing it later."

Findings from several clinical trials suggest that there's a longer period of time before the myeloma relapses when a person undergoes this transplant as part of initial treatment compared to those who have the procedure done later on.

Stem Cell Transplant Considerations

For some people with multiple myeloma, a stem cell transplant is never an option. The procedure requires an individual to undergo high-dose chemotherapy, sometimes with radiation, to kill the myeloma cells in the bone marrow. But because the chemotherapy also kills healthy blood cells, the side effects can include extreme fatigue, nausea and vomiting, peripheral neuropathy, kidney problems, and other physical and mental consequences.

The additional side effects of this procedure can be even more severe. This is why people who are frail or who have cardiovascular disease, kidney or liver problems, or diabetes may be poor candidates for a stem cell transplant.

RELATED: How to Determine if a Multiple Myeloma Patient is Eligible for a Stem Cell Transplant

There are two main types stem cell transplants: autologous transplants that use the patient's own stem cells that are harvested and stored before any treatment and allogenic transplants that use stem cells from a donor often a family member. Allogenic transplants carry more risk and are not yet widely commonly performed, though studies suggest they may be more effective at destroying cancer cells.

In both types of transplants, stem cells are injected into the vein following high-dose chemotherapy. "After a period of time, these stem cells will go to the patient's bone marrow and regrow the blood-forming system," Dr. Pianko says. "After a period of approximately one to two weeks, we generally expect that the patient's blood cells the white blood cells, red blood cells, and their platelets will recover to normal levels and we'll allow them to be sent home from the hospital."

Stem Cell Alternatives

For people who cannot have a stem cell transplant or choose not to have the procedure, other treatments may be considered. These include:

• Targeted therapy, in which drugs such as proteasome inhibitors are taken to block the actions of certain proteins and other molecules necessary for cancer cells to multiply.
•  Immunotherapy, which uses immunomodulating drugs to bolster the body's own immune system to fight the disease.
• Corticosteroids, which also act on the immune system to help reduce inflammation and fight myeloma cells.

Takeaway

Dr. Pianko says that while there is some debate about whether a stem cell transplant should be pursued with every patient, the decision to perform a stem cell transplant and when to do so should made on a case-by-case basis, taking into consideration the health and preferences of the patient.

"There's a consideration of benefits and risks for this type of treatment," Dr. Pianko says. "It must be approached in a personalized way for each patient."

As you and your doctors map out a treatment plan, be sure to have an open and honest conversation about the risks and side effects, as well as the likely benefits including the time before relapse a stem cell transplant may afford you.

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