Is the Stem Cell Transplant Still Needed?
- After the induction phase of multiple myeloma treatment, a stem cell transplant is typically the next step. This procedure is usually done without the disease returning, or before it does.
- There are three types of transplants: autologous stem cell transplant, allogeneic transplant and syngeneic transplant.
- Dr. Dickran Kazandjian says that doctors are asking whether transplant is still necessary as myeloma patients are achieving deeper remissions with drugs.
Dr. Dickran Kazandjian, a multiple myeloma specialist at the Sylvester Comprehensive Cancer Center in Miami, Fla., tells SurvivorNet that in his practice, he recommends all patients get their stem cells harvested in case they need a transplant down the road.
Read MoreBefore understanding whether or not a transplant is right for you, it is important to understand the three types of transplants available to multiple myeloma patients who are eligible (because there are some myeloma patients who are not eligible due to the toll it takes on your body).
Autologous Stem Cell Transplant
The first type, and typical option for a stem cell transplant, is called the autologous stem cell transplant.
This transplant is when your own healthy stem cells are removed from your bone marrow prior to chemotherapy and then are re-inserted, or put back, into your bone marrow following therapy.
It should be noted that an autologous transplant is currently the standard of care for multiple myeloma patients who undergo a stem cell transplant.
RELATED: Stem Cell Transplants for Multiple Myeloma — Inpatient or Outpatient?
"In some ways, I always felt that the (autologous) transplant is probably even somewhat of a little bit of a misnomer in the sense that it's not like an allogeneic transplant where you're really looking for an immune based response," Dr. Kazandjian says. "Rather, the (autologous) transplant part is when you get your own cells transplanted back, because you received very high-dose chemotherapy."
Allogeneic Transplant
The second type of transplant, and a more experimental option, is called an allogeneic transplant, which is what Dr. Kazandjian previously mentioned.
With this type of stem cell transplant, stem cells are taken from a healthy donor who closely matches your body's cell type; this person 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 fight off and kill cancer cells, as well.
However, new immune cells formed from the donor stem cell transplant could start attacking your own tissues and organs as foreign invaders, like they would an infection. This can have serious long-term consequences, and so an allogeneic transplant is currently only approved in clinical trials.
Syngeneic Transplant
The syngeneic stem cell transplant is a special kind of allogeneic transplant a more experimental option that can only be performed on patients who have an identical sibling, like a twin or a triplet. This person has to have the exact same tissue type as the person receiving the stem cell transplant.
There are advantages to this procedure, as well as disadvantages, of course. An advantage is that graft-versus-host disease will not be a problem. In addition, unlike an autologous transplant, there are also no cancer cells in the transplanted stem cells.
However, a disadvantage of the syngeneic transplant is that because the new immune system is so much like the recipient's immune system, there is no graft-versus-cancer effect.
Is the Stem Cell Transplant Still Needed?
Is the stem cell transplant still needed? This is a question Dr. Kazandjian says doctors are currently asking.
"The reason we ask that question is you can imagine high-dose chemotherapy with transplant is not the most benign thing to undergo," Dr. Kazandjian says, "but there are still risks."
"That being said, really no clinical trial using a triplet like I mentioned … has ever shown to increase survival when you use the high-dose melphalan up front."
"Now we have the quadruplet therapies, like I mentioned, and we're getting such deep response rates that are MRD-negative (no disease was detected after treatment), even close to 70 (percent) to 80 percent," Dr. Kazandjian adds. "I think this chapter is not a closed one with high-dose melphalan and transplant and is gonna remain open and up to debate."
Dr. Kazandjian says that in reality, professionals in the multiple myeloma field are split about half and half on this debate. But at the University of Miami, he says that he and his colleagues are generally in agreement that patients do not necessarily need to receive this high-dose chemo and a transplant "if their response initially is fairly deep."
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