Stem Cell Transplants for Multiple Myeloma
- Autologous stem cell transplantation has been an important treatment intervention in multiple myeloma since the 1980s. The main risks of a stem cell transplant are the toxicities of chemotherapy. These treatments can damage the bone marrow and other organs, which can lead to life-threatening infections, bleeding, and other problems.
- Despite the risks, many patients with myeloma undergo transplant after induction chemotherapy. This is controversial because there is no clear evidence that it improves survival.
- If transplant is part of your treatment plan, it’s important to talk to your doctor about the risks and benefits. You should also ask about the transplant center’s experience with this type of treatment and how they will monitor your health.
Autologous stem cell transplantation has been an important treatment intervention in multiple myeloma since the 1980s. Although stem cell transplant is effective for many, relapse after transplant is expected at some point.
Read MoreTransplant Risks
“Transplant has been developed for many years,” Dr. Landgren said. “It is clearly a therapy that has the myeloma effect is well-documented, but it also has a lot of toxicity.” RELATED: How Do Stem Cell Transplants Work for Multiple Myeloma?The main risks of transplant are the toxicities of chemotherapy. These treatments can damage the bone marrow and other organs, which can lead to life-threatening infections, bleeding, and other problems.
Transplant may require a hospital stay that can last several weeks. You may lose your hair, experience nausea and vomiting, and feel very tired. Your risk for developing infection will be higher, which means taking special precautions to avoid germs.
“The immune system will be suppressed for a long time,” adds Dr. Landgren. The antibodies you received through childhood vaccinations will not be as effective, and transplant patients will need to be re-vaccinated down the road.
The Controversy of Transplant After Induction
Despite the risks, many patients with myeloma undergo transplant after induction chemotherapy. This is controversial because there is no clear evidence that it improves survival.
RELATED: Stem Cell Transplant for Multiple Myeloma: Inpatient or Outpatient?
“It does not extend overall survival based on modern studies, comparing modern therapy with and without transplant,” explains Dr. Landgren. “So the controversy is if it adds additional follow-up time.”
For many, deciding whether to undergo a transplant after induction chemotherapy is a difficult decision. You need to weigh the risks and benefits of the treatment and discuss them with your doctor.
“I think there is very strong evidence in the literature that if you can achieve minimal residual disease negativity, that the additional value of transplant is either nothing or very minimal,” Dr. Landgren says. He adds that patients should make this decision with their medical team after reviewing research studies and discussing their own values.
“I usually involve the transplant center or transplant service with these discussions as well,” Dr. Landgren says. “I want the patient to have all the information and then we make decisions together.”
Talking to Your Doctor
If transplant is part of your treatment plan, it’s important to talk to your doctor about the risks and benefits. You should also ask about the transplant center’s experience with this type of treatment and how they will monitor your health.
Dr. Landgren addresses the complexity of the choice. “Multiple myeloma is a quite complicated disease to treat these days. There are so many drug combinations and there’s a lot of controversy on the optimal way of doing it.”
Your response to induction therapy, overall condition, and other factors affect the type of treatment you receive. You’ll need to weigh the risks and benefits of the treatment, discuss them with your doctor, and make this important decision together.
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