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Autologous Stem Cell Transplant for Multiple Myeloma- What you Need to Know

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The overriding truth in the risk vs. reward analysis for you in your specific MM situation is that the technology of hematopoietic stem cell transplant is constantly changing. Therefore understanding the questions to ask your onc is as important as getting the answers.

The first challenge of the newly diagnosed multiple myeloma (MM) patient is that an autologous stem cell transplant (ASCT) is considered to be standard-of-care MM therapy and therefore pushed by the majority of oncologists.

The second challenge is that an ASCT has NEVER delivered a longer, average overall survival and often results in a host of short, long-term and late stage side effects.

Regardless, it is in the best interests of all newly diagnosed MM patients to learn about auto and allo stem cell transplants in order to be educated as to whether or not an ASCT is right for you.

A hematopoietic stem cell transplant, commonly called a bone marrow transplant (BMT) is one of conventional oncology’s most aggressive procedures and often the best hope for a deep or complete remission. If you are considering a BMT you must weight the risks versus potential rewards in comparing single or combination chemotherapy in multiple myeloma, lymphomas or leukemias.”

If your oncologist has mentioned any kind of stem cell transplant as a component of your treatment plan, read the post below to learn the pros, cons, and side effects of a bone marrow transplant. The vast majority of articles and blog posts on PeopleBeatingCancer pertain to the subject of hematopoietic stem cell transplantation. Therefore, understanding the BMT basics are key to asking the right questions and making the best treatment decisions for you.

Questions to ask your onc based on the information below are:

  1. How many bone marrow transplants of the type that you are recommending have you performed for multiple myeloma? This institution?
  2. What will my prognosis be based on an ASCT? What are the odds of a complete remission, partial remission or little if any remission? Can you show me studies that clearly indicate that an ASCT will give me longer overall survival (live longer)?
  3.  What are the risks of this type of BMT that you are recommending for me in my situation? Why are you recommending an auto over an allo, or using cord blood over an mini-allo?
  4.  Why are you recommending a BMT over less aggressive, less toxic and less expensive therapies such as a chemo cocktail?

I am both a multiple myeloma survivor and MM cancer coach.   Have you been diagnosed with multiple myeloma? What symptoms, what stage? Please learn about both conventional and evidence-based non-conventional therapies for multiple myeloma.

Please scroll down the page, post a question or comment and I will reply ASAP.

Knowledge is Power!

David Emerson

  • Multiple Myeloma Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood. It is a medical procedure in the fields of hematology and oncology, most often performed for patients with certain cancers of the blood or bone marrow, such as multiple myeloma or leukemia. In these cases, the recipient’s immune system is usually destroyed with radiation or chemotherapy before the transplantation. Infection and graft-versus-host disease is a major complication of allogenic HSCT.

Hematopoietic stem cell transplantation remains a dangerous procedure with many possible complications; it is reserved for patients with life-threatening diseases. As the survival of the procedure increases, its use has expanded beyond cancer, such as autoimmune diseases.[1][2]

Graft types

1) Autologous

Autologous HSCT requires the extraction (apheresis) of haematopoietic stem cells (HSC) from the patient and storage of the harvested cells in a freezer. The patient is then treated with high-dose chemotherapy with or without radiotherapy with the intention of eradicating the patient’s malignant cell population at the cost of partial or complete bone marrow ablation (destruction of patient’s bone marrow function to grow new blood cells).

2) Allogeneic

Allogeneic HSCT involves two people: the (healthy) donor and the (patient) recipient. Allogeneic HSC donors must have a tissue (HLA) type that matches the recipient. Matching is performed on the basis of variability at three or more loci of the HLA gene, and a perfect match at these loci is preferred. Even if there is a good match at these critical alleles, the recipient will require immunosuppressive medications to mitigate graft-versus-host disease. Allogeneic transplant donors may be related (usually a closely HLA matched sibling), syngeneic (a monozygotic or ‘identical’ twin of the patient – necessarily extremely rare since few patients have an identical twin, but offering a source of perfectly HLA matched stem cells) or unrelated (donor who is not related and found to have very close degree of HLA matching)

Sources of cells

  • Bone marrow-In the case of a bone marrow transplant, the HSC are removed from a large bone of the donor, typically the pelvis, through a large needle that reaches the center of the bone…”
  • Peripheral blood stem cells-“Peripheral blood stem cells[23] are now the most common source of stem cells for allogeneic HSCT. They are collected from the blood through a process known as apheresis…”
  • Amniotic fluid-“It is also possible to extract hematopoietic stem cells from amniotic fluid for both autologous or heterologous use at the time of childbirth.”
  • Umbilical cord blood-“Umbilical cord blood is obtained when a mother donates her infant’s Umbilical Cord and Placenta after birth…”

Conditioning regimens

  • Myeloablative transplants-“The chemotherapy or irradiation given immediately prior to a transplant is called the conditioning regimen, the purpose of which is to help eradicate the patient’s disease prior to the infusion of HSC and to suppress immune reactions…”
  • Non-myeloablative allogeneic transplants– “This is a newer treatment approach using lower doses of chemotherapy and radiation, which are too low to eradicate all the bone marrow cells of a recipient…”

Advances in Stem Cell Transplantation Strategies Show Promise to Improve Availability, Success

” Hematopoietic stem cell transplantation (HSCT), once considered an effective yet risky alternative to drug therapy for blood cancer, has become more accessible and successful in a wide range of patients as a result of major advances in transplant strategies and technologies…

HSCT is effectively used today as a form of “replacement” therapy for patients with hardtotreat blood cancers, providing healthy cells from either the patient (autologous transplantation) or from a donor (allogeneic transplantation) to better equip patients to fight the disease on their own…

Researchers also contend that transplant outcomes can be further improved by identifying patients who are at high risk for certain complications, such as cognitive decline, or by employing post-transplant treatments to reduce their risk of relapse…

As we are now able to focus our efforts on improving the overall patient experience and reducing the risk of relapse, the leading cause of death after transplant, we have greatly improved longterm survival outcomes for patients who before might not have had another treatment option.”

Scientists Control Cells Following Transplantation, from Inside out

“…Cells are relatively simple to control in a Petri dish. The right molecules or drugs, if internalized by a cell, can change its behavior; such as inducing a stem cell to differentiate or correcting a defect in a cancer cell. This level of control is lost after transplantation as cells typically behave according to environmental cues in the recipient’s body. Karp’s strategy, dubbed particle engineering, corrects this problem by turning cells into pre-programmable units. The internalized particles stably remain inside the transplanted cell and tell it exactly how to act, whether the cell is needed to release anti-inflammatory factors or regenerate lost tissue…”

 Now that you know all there is to know about bone marrow transplants, (or you may be thoroughly confused) email me, your cancer coach, with any and all questions you may have about your own blood cancer diagnosis, staging, genetic involvement, etc.

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