Following the first phase of myeloma treatment, patients undergo the second phase, the stem cell transplant. Stem cell transplant for myeloma is not like an organ transplant of the liver or heart. Dr. Sagar Lonial, Chief Medical Officer at the Winship Cancer Institute of Emory University explains, "When we think about transplant for myeloma, one of the first things I do when I see a new patient is tell them 'It’s not really a transplant.' It’s very different from what their idea of what a stem cell transplant is." So with a stem cell transplant for multiple myeloma what should you expect?
What is transplanted is the patient’s own stem cells in the bone marrow, and not until after a high dose of chemotherapy. Doctors want to eliminate as many cancerous cells from the bone marrow as possible and they do this through a high dose of chemotherapy known as Alkeran (Melphalan). In reality, the 'stem cell transplant' is just another treatment. "In myeloma, what we’re really doing is delivering another treatment, and that treatment is high dose of chemotherapy. We rescue you with your own cells. So it’s really: high dose chemotherapy with rescue. It’s not truly a transplant. You don't reject these cells," says Lonial.Read More
The timeline for treatment, starting with high dose Alkeran, is as follows:
- Day Minus One–This is the term oncologists use to denote the day that patients receive high-dosage of chemotherapy.
- Day Zero–patients are given a blood transfusion of their own stem cells.
- Day Three–the blood counts of patients can reach nearly zero. There is typically a delay from when high dose chemotherapy is administered to when the toxic effects are seen in the body. So widespread low blood cell counts are not measured until four days after chemotherapy
- Day 7-10–patients blood counts are back to normal. Similarly to chemotherapy, there is a delay from when the stem-cell transplant is infused until its positive effects are seen in the body. So blood counts do not reach normal levels until then. Patients' blood counts are monitored until then and they are given extra blood transfusions if needed.
- After Day 10–at this juncture patients are, according to Dr. Vincent Rajkumar, medical oncologist at the Mayo Clinic, "end-graft." In other words, "new bone marrow starts forming, new blood cells come out, and the myeloma has been taken care of. "
Starting with collection of stem cells and ending with full recovery, stem cell transplantation spans about 2-3 weeks, depending on how long it takes for patients to recover. Dr. Rajkumar summarized the process of receiving chemotherapy followed by transplant: "There is no surgery involved. It’s basically like giving an IV medication for a day or two, and then giving a blood transfusion. That’s all that’s involved."