Autologous stem cell transplant for multiple myeloma
Fact-checked by An autologous stem cell transplant (ASCT) is an intensive cell therapy that some people with multiple myeloma undergo to help the body produce new healthy blood cells and keep the disease under control for as long as possible.
Multiple myeloma is a type of blood cancer that affects plasma cells, a class of immune cells (white blood cells). Cancerous plasma cells, or myeloma cells, grow out of control in the bone marrow, disrupting normal blood cell production and causing other problems throughout the body.
ASCT uses a patient’s own cells to help restore healthy blood cell production after high-dose chemotherapy. It is typically used alongside other multiple myeloma therapies. For many eligible patients, the treatment helps maintain remission — a period of low or undetectable cancer activity — for longer than could be achieved with medications alone, although it is not generally curative.
What is an autologous stem cell transplant?
ASCT is a type of cell therapy, meaning it involves transferring living cells into a person for a therapeutic effect. While some cell therapies require donor cells, ASCT uses a patient’s own cells. In multiple myeloma, the cells that are transplanted are hematopoietic stem cells, or HSCs, which are the precursors that give rise to mature blood cells.
Myeloma itself impairs healthy blood cell production, and treatments can also damage blood cells. Basically, ASCT uses a person’s own HSCs to help repopulate the body with healthy blood cells. The process typically involves several steps:
- Induction therapy: Patients receive a combination of medications designed to kill myeloma cells, aiming to achieve remission. The duration can vary, but induction usually takes about 3-6 months.
- Stem cell mobilization: Therapies designed to move stem cells from the bone marrow into the bloodstream may be administered. This typically involves up to a week of daily injections, but not everyone undergoes it.
- Stem cell collection: A process called apheresis collects stem cells from blood, returning the remaining blood to the patient’s body. This may take one or more days until enough cells are collected, with each session lasting three to four hours. The cells are frozen until they are needed.
- Chemotherapy: Patients are given high-dose chemotherapy (conditioning regimen) to destroy remaining myeloma cells and make room in the bone marrow. This is typically done over one to two days.
- Stem cell infusion: A few days after conditioning, patients receive an intravenous infusion of their HSCs. This takes a few hours.
Once in the body, HSCs migrate to the bone marrow, where they can produce new blood cells to replace those lost.
Throughout the process, doctors will closely monitor patients for side effects. This may involve staying at the hospital or receiving outpatient care for two or three weeks. On average, it takes about three to six months to recover from ASCT, though patients may take longer to feel fully back to normal.
After the transplant, doctors may recommend maintenance therapies, which are other myeloma medications designed to prolong remission and prevent myeloma from returning.
Autologous stem cell transplant for multiple myeloma
ASCT is one of many treatment options for multiple myeloma. Patients and doctors need to consider individual circumstances and preferences when choosing an appropriate treatment path and deciding if ASCT is a good fit.
Part of this consideration involves determining if patients are eligible for a transplant. Eligibility requirements may vary, but generally, doctors will take into account several factors, including:
- general fitness and health
- any other illnesses
- kidney, heart, lung, and liver function
The timing of ASCT can also vary. Often, doctors recommend a transplant early, after the first line of induction treatment, because this could improve quality of life and increase the chances of achieving sustained remission. For others, ASCT may be part of a later round of therapy.
Doctors may recommend a double, or tandem, transplant in certain high-risk cases where the cancer is likely to be aggressive and fast-growing. The two procedures are typically separated by about three to six months to allow for recovery between them. This may help make the treatment more effective, though side effects can also be worse.
Regardless of treatment, most people with multiple myeloma experience a return of the cancer, or relapse. The goal of ASCT is to prolong remission, but it is not usually a cure, and it will not permanently prevent future relapse.
While most people who undergo ASCT only do so once, some people may get a second transplant later on if they have relapsed and responded well to the first transplant.Â
Side effects
While the side effects of ASCT may vary, some common ones include:
- nausea
- mouth sores
- hair loss
- infection
- fatigue
- diarrhea
- skin rash
Infection is a particular concern after ASCT because chemotherapy kills the immune cells needed to fight bacteria, viruses, and other harmful invaders. Until the transplanted stem cells begin to produce new blood cells, these immune functions are compromised. Preventive antibiotics and hygiene precautions may help reduce the risk of infections.
Some people experience a temporary inflammatory condition called engraftment syndrome after ASCT. This may be accompanied by symptoms such as fever, skin rash, nausea, diarrhea, and difficulty breathing.
Rarely, ASCT can trigger autologous graft-versus-host disease, a serious autoimmune reaction that can damage organs, including the skin, gastrointestinal system, and liver. In some cases, this reaction can be life-threatening.
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
