Some people with myeloma may have high-dose chemotherapy followed by a stem cell transplant, also called a hematopoietic cell transplant. This treatment tends to give the best results in terms of slowing or stopping the disease and prolonging survival in people who are good candidates. In general, good candidates are people younger than 70 years old who are in good physical condition and whose heart, lungs and kidneys are working well. These factors are important because the chemotherapy that precedes a transplant is challenging for the body.
The high-dose chemotherapy given before a transplant is designed to kill as many myeloma cells in the body as possible. This type of pre-transplant conditioning regimen is called myeloablative. It destroys the patient’s own bone marrow and immune system. When bone marrow is healthy, it produces stem cells. These are primitive cells that develop into important blood cells—including white blood cells to fight disease, red blood cells to carry oxygen and platelets to help blood clot. Bone marrow that is damaged by high-dose chemotherapy can no longer produce new stem cells on its own.
So, after the high-dose chemotherapy, doctors give the patient an infusion of stem cells to create new bone marrow. This is the transplant itself. It helps the body recover from the effects of the chemotherapy. The transplant may be done using stem cells removed from the circulating blood (called a peripheral blood stem cell transplant, or PBSC transplant) or using stem cells taken from the bone marrow (called a bone marrow transplant, or BMT).
Usually for myeloma the stem cells are removed from the patient before the high-dose chemotherapy and stored until they can be reinfused into the body. This is called an autologous transplant, meaning a transplant using the patient’s own stem cells. Sometimes doctors recommend a second transplant within the next 6 to 12 months.
Some patients with myeloma may receive an allogeneic transplant—that is, using stem cells from a donor.
Patients having an allogeneic transplant also undergo conditioning. Some have myeloablative conditioning; others have lower-intensity conditioning, called nonmyeloablative. (You may also have heard this called mini-transplant.) This type of regimen destroys some of the myeloma cells and bone marrow. The intent is to suppress the immune system enough so that the donor cells are not rejected and can help to kill remaining myeloma cells by an immune attack on those cells.
Read more about our Transplant Program.