Stem Cell Transplant for Multiple Myeloma – Side Effects

If you’re eligible for a stem cell transplant, the data is clear: patients who get one live longer than those who don’t. However, not everyone is eligible for a stem cell transplant because of the toll it takes on your body.

The goal of the transplant is to kill off as many cancerous cells as possible through a round of high dosage chemotherapy. The stem-cell transplant itself is actually used as a rescue therapy to replenish healthy cells following the harsh chemotherapy.

The chemotherapy used prior to the stem-cell transplant is known as Alkeran (melphalan), and kills cancer cells through a process that interferes with the cell’s ability to create new genetic material. This ability is essential for tumor cells to not only survive, but also to replicate and divide. Thus, melphalan is highly effective in killing off cancer cells and preventing multiple myeloma tumors from growing back. However, melphalan can also kill healthy cells, and so the drug comes with serious side effects.

The majority of patients tolerate this phase of treatment quite well, but they are at risk of experiencing both short and long term side effects.

In the short term, about two to three weeks following treatment, patients can experience:

• Mouth sores
• Diarrhea
• Infection and anemia, resulting from a low blood count
• Bleeding

The long-term side effects, which can last for months and even years after treatment, can include:

• Fatigue
• Neuropathy, which is damage to the nerve endings that can cause weakness, numbness, and pain
• Acute myeloid leukemia, another cancer of the blood
• Myelodysplasia, a condition where blood forming cells in the bone marrow become abnormal

Patients can develop myelodysplasia syndrome because of the chemotherapy they get prior to transplant. The chemotherapy can cause healthy stem cells–those responsible for blood cell production–in the bone marrow to become defective. These defective cells then have issues producing healthy blood cells for the body, leading to long-term anemia.

Acute myeloid leukemia, is another cancer that originates in the bone marrow. It may seem ironic that treatment for one cancer can cause another. Unfortunately, that’s what happens. The chemotherapy can cause specific stem cells in the bone marrow to become cancerous even though the drug is also killing cancer cells.

Although the risk of developing myelodysplasia and acute myeloid leukemia following chemotherapy is low, they hold serious consequences, so oncologists like Dr. Paul Richardson of the Multiple Myeloma Center at Dana Farber Cancer Institute are hoping to find ways of understanding which people may be at a high risk of these long-term side effects.

“We’re desperately trying to figure out…who may be particularly prone to [side effects], and at the same time trying to recognize those who may not be prone to them so they could potentially benefit from the actual approach.”

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