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Auto Stem Cell Transplant Second Thoughts
Hi David- I am supposed to be starting my autologous stem cell transplant (ASCT) tomorrow. I am having outpatient chemo and being admitted the next day to the hospital for two weeks. I am a bit frightened of the long-term and late stage side effects of chemotherapy.
I’ve decided I could probably get through the next month or two if I thought at the end of the day my life will be better and longer. Hi do not know what the long-term side effects are. I guess they’re different for everyone but now I’m wavering on whether I should put this off until I know more or not. Nicki
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Hi Nicki-
The decision to have an ASCT or not is up to you of course. The issues you raise below all depend on studies at this time because, as you point out, everyone is different.
The issues for you to consider, based on my experience and based on the questions from other MM patients are:
Will I achieve a longer progression-free survival (first remission) and longer overall survival (length of life).
Studies indicate that ASCT can mean a longer PFS. But not a longer length of life.
What are the possible side effects of an ASCT? There are many possible side effects of both an ASCT or regular chemotherapy.
The issue comes down to how much total toxicity are you undergoing. An ASCT is more chemo and therefore a higher risk of side effects.
Lastly, what is the alternative to an ASCT? The answer to that question is/are chemotherapy combinations often referred to as “novel therapies.” If you choose this path I encourage you to work with a MM specialist.
Let me know if you have any questions.
Hang in there,
David Emerson
MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer
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Recommended Reading:
Multiple Myeloma Treatment, Immunotherapy w/ Antibiotics
Multiple Myeloma Chemotherapy Kills (SAE/FAE)
Healing Hemorrhagic Cystitis aka Irritable Bladder
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Side Effects of a Bone Marrow Transplant (Stem Cell Transplant)
“Many side effects go away with time, but some can be permanent. It is a good idea to talk with your health care team about all of the possible side effects before starting your transplant process…
What are the side effects of an autologous transplant?
An autologous stem cell transplant is also called an AUTO transplant or stem cell rescue. An AUTO transplant uses your own stem cells as the replacement cells. A doctor gives them back to you after you have chemotherapy, with or without radiation therapy. Many side effects of an AUTO transplant are similar to side effects from chemotherapy and side effects of radiation therapy. The most serious side effect is a higher risk of infection from your body’s low levels of white blood cells.
Infections
Chemotherapy and some other treatments weaken your body’s infection-fighting system, called the immune system. This is especially true of treatment given for a bone marrow/stem cell transplant, because the bone marrow is part of the immune system. When your immune system is weakened, your body cannot protect itself as well against germs. Most of these germs already live in your body. When your immune system is strong, these germs do not make you sick. But after a transplant, they can cause an infection.
Fortunately, most of these infections are fairly easy to treat with antibiotics. After about 2 weeks from your transplant day, the immune system cells called neutrophils will begin recovering. Neutrophils keep some common germs from making you sick.
You have the highest risk of infections in the first few weeks after transplant. However, your immune system may need a long time to recover after a transplant. You may need to take medications to fight infection for a year or more after your bone marrow/stem cell transplant. Your health care team will talk with you about ways to reduce your risk of infections by taking precautions during your recovery.
Learn more about infections as a side effect of cancer treatment.
Other immediate side effects
The following side effects can develop right after the high doses of chemotherapy used for AUTO transplantation.
- Nausea and vomiting
- Sores in your mouth
- Fatigue
- Low levels of platelets, making it more difficult for your blood to clot
- Low levels of red blood cells, causing anemia
- Diarrhea
Long-term side effects
Some transplant side effects happen months or years later. These can include:
- Infertility, meaning you cannot become pregnant or make a woman pregnant when you want to
- Cataracts, an eye condition that causes cloudy vision
- Sexual side effects and early menopause
- Thyroid problems
- Lung or bone damage
- Another cancer
Early versus delayed autologous stem cell transplantation in patients receiving novel therapies for Multiple Myeloma
“In conclusion, we found no statistically significant differences in PFS and OS between the early versus late ASCT groups. . A major limitation of this study is that we do not know the reason(s) for the late referral for patients in the late ASCT. Reasons could be patient initial refusal, physician preference because patients were doing well with induction or initial feeling that patients may not be good candidates for ASCT. Also, this study is a retrospective analysis and likely the number of patients may not be powered to attain statistical significance. We excluded patients who received maintenance treatment post ASCT as this was not balanced between the two groups. Although retrospective, these data support the ongoing prospective randomized trial examining this important question (NCT01191060, NCT 1208662, and NCT00551928)…”