A stem cell transplant is not like an organ transplant of the liver or heart. What is transplanted is the patient’s own stem cells in the bone marrow. The goal of the transplant is to deliver a high-dose of chemotherapy, then rebuild, or rescue, the patient by putting stem cells back in the body. Doctors want to eliminate as many cancerous cells from the bone marrow as possible. In the stem cell transplant they use a chemotherapy known as Alkeran (Melphalan).
High dose Alkeran is most effective in killing the most myeloma cells, but because of its high dosage, it also eliminates many of your body's healthy cells in the bone marrow, such as those that eventually create red blood cells and white blood cells. The elimination of these important blood cells during the transplant can put the patient at risk for infection and bleeding. As a result, patients must be pre-screened for eligibility to handle the treatment. Oncologists typically do not allow transplant for individuals over age 65 or those who have had major major health problems, such as serious heart, lung, liver, or kidney disease.
Read More There are two types of stem cell transplants typically used to treat diseases. The first is the
autologous stem cell transplant. During an autologous stem cell transplant, your own healthy stem cells are removed from your bone marrow prior to chemotherapy and then are re-inserted into the bone marrow following therapy. Autologous transplant is currently the standard of care for multiple myeloma patients who undergo stem cell transplant. The second experimental form of stem cell transplant is the
allogenic transplant. An allogenic transplant takes stem cells from a healthy donor that closely matches your body's cell type and may even be related to you. This transplant is promising because these new donor stem cells not only replenish your own stem cell stores, but can actually help kill off cancer cells as well. However, new immune cells formed from the donor stem cell transplant might start attacking your own tissues and organs as foreign like they would an infection. This can have serious long-term consequences, and so allogenic transplant is currently only approved in clinical trials. In contrast, autologous stem cell transplant is a very safe treatment.
Dr. Vincent Rajkumar, medical oncologist at the Mayo Clinic, explains, "Autologous stem cell transplantation for multiple myeloma is extraordinarily safe. We hardly have a 1-2% chance of dying during the transplant process or in the one-year period [afterward]. Almost 50-60% of patients at Mayo Clinic, for example, are treated entirely as an outpatient for the autologous stem cell transplant."
Dr. Rajkumar says that autologous stem cell transplant is "something that prolongs survival in myeloma and therefore is a mainstay of the treatment of myeloma, for patients who are eligible for the procedure."
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Dr. S. Vincent Rajkumar, MD is engaged in clinical, epidemiological and laboratory research in myeloma and related disorders. Read More
