A hematopoietic stem cell transplant, commonly called a bone marrow transplant (BMT) is one of conventional oncology’s most aggressive procedures
A stem cell transplant is part of the standard-of-care therapy plan for all newly diagnosed myeloma patients. As I outlined in my explanation of the prognosis for multiple myeloma, the therapy plan is:
Whether or not you are eligible for a stem cell transplant depends on your overall health, multiple myeloma staging, and the multiple myeloma diagnostic criteria you meet — including blood and imaging tests.
What is Stem Cell Transplantation?
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.
A Stem Cell Transplant is one of conventional oncology’s most aggressive procedures. It is also known for a lot more chemotherapy for the chance at a longer first remission. It is designed to kill more Multiple Myeloma cells, but patients must ensure more toxicity to do so, creating more organ damage. With more chemotherapy comes a higher risk of short, long-term and late-stage side effects.
It may be autologous (the patient’s own stem cells are used), allogeneic (the stem cells come from a donor) or syngeneic (from an identical twin). Different transplant therapies involve different risks and short, long-term and late stage side effects.
How Does a Bone Marrow Transplant Work?
- All patients considering a stem cell transplant will undergo induction therapy in order to reduce the amount of plasma cells (myeloma cancer cells) in their bone marrow.
- Once your myeloma is under control, the patient undergoes the harvesting of their stem cells.
- Once the patient has harvested the necessary quantity of his or her own stem cells, they are ready to undergo an autologous stem cell transplant.
- Keep in mind that the oncologist themself should be a specialist in multiple myeloma as well. You can find information here about the top Multiple Myeloma Hospitals and Multiple Myeloma specialists.
- While receiving a stem cell transplant can cause multiple myeloma to go into remission, it isn’t a cure. This means it can come back in the future.
While a stem cell transplantation is a piece of the Standard-of-care therapy plan for the newly diagnosed multiple myeloma patient, numerous studies confirm that a stem cell transplant allows for a longer first remission (PFS) but not a longer length of life or overall survival.
And a stem cell transplant definitely increases your risk of short, long-term and late stage side effects.
The challenge that patients face is that an ASCT has real strengths and weaknesses. In order to make the best decision for you, you have to learn about these pros and cons as quickly as possible.
Big Picture — Try to think about your:
- goals (length of life, quality of life)
- health (do you have any co-morbidities- heart, kidney, etc?)
- job (Are you retired? Working?)
- health insurance (what is covered? What isn’t?)
Specifics — Those questions apply to you in your particular situation. These questions apply to everyone:
- Does an autologous stem cell transplant help patients live longer?
- What types of damage does the toxicity of an autologous stem cell transplant involve?
The purpose of this post is to outline the intricacies of autologous stem cell transplantation in myeloma so that you, the patient, can learn about the many different challenges you face with or without undergoing an autologous stem cell transplant.
ASCT Challenge #1 — Big Picture Issues
I’ve researched and writen about the big picture issues in the blog posts linked below.
ASCT Challenge #2 — Specifics
Progression-free survival vs. Overall survival
Study after study concludes that an autologous stem cell transplant does one thing and one thing only. It may give the patient a longer first remission. And what it costs the patient is toxicity. An autologous stem cell transplant is lots more chemotherapy for the chance at a longer first remission. With more chemotherapy comes a higher risk of short, long-term and late stage side effects.
ASCT Challenge #3 — Short, long-term and late stage side effects
An autologous stem cell transplant is aggressive treatment. Yes, an ASCT will probably lead to a longer first remission. But I believe myeloma survivors should think beyond their first remission. I read about too many MM survivors who relapse after a couple, two, three years. And they’ve undergone a lot of toxicity in order to achieve those two or three years of first remission.
And toxicity leads to short, long-term and late stage side effects.
Are you considering an autologous stem cell transplant? What was your stage and symptoms when you were first diagnosed? How old are you? How is your health… beside your myeloma, I mean.
You should feel prepared when making decisions about a stem cell transplant for multiple myeloma. Learn more about using evidence-based therapies to your advantage today.
To ask a question or make a comment, scroll down the page, write a post and I will reply to you ASAP.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
