Stem Cell Transplant–How Will I Feel?

The goal of the stem cell transplant, often the second phase of multiple myeloma treatment, is the same as the first phase. Doctors want to eliminate as many cancerous cells from the bone marrow as possible. But in the stem cell transplant, they use a chemotherapy known as Alkeran (Melphalan) before performing an autologous stem cell transplant. During an autologous stem cell transplant, your own healthy stem cells are removed from your bone marrow prior to chemotherapy and then are re-inserted into the bone marrow following therapy, replenishing healthy cells. What makes it difficult is the need for high-dose chemotherapy.

High dose Alkeran is most effective in killing the most myeloma cells, but because of its high dosage, it also eliminates many of your body’s healthy cells in the bone marrow, causing a variety of short-term side effects, including:

• Fatigue: This is usually the first symptom to appear. In multiple myeloma, cancerous plasma cells grow uncontrollably in the bone marrow and crowd out other functioning white blood cells. As a result, the immune system can’t properly fight off infection, causing fatigue. “Some people describe it as a very bad flu,” explains Dr. Caitlin Costello, hematologist-oncologist at UCSD.
• Fever: The greater risk for infections caused by your suppressed immune system can also bring about fevers. “I usually tell patients that I expect everyone to have a fever, and I’m pleasantly surprised if it doesn’t happen,” says Dr. Costello.
• Upset stomach: Chemotherapy can cause both increased (rapid) and decreased (slow) motility of the intestines. In other words, the normal action that moves stool through the bowel may be faster or slower than usual, which can cause either diarrhea and/or constipation. The drug can also affect helpful bacteria in the gut, creating problems with digestion.
• Mouth sores: Cells that line the inside of your mouth are especially susceptible to damage from chemotherapy, causing mouth sores.
• Hair loss: Rapidly growing cells in the body, like those in your hair roots, are also especially susceptible to damage. “Some people notice that when they’re brushing their hair, that it may start coming out more than you had notice before,” says Dr. Costello. Not to worry though, the hair loss is almost always temporary.

These side effects usually begin to appear by the fourth day following chemotherapy. What percentage of patients experience side effects? A 2017 study found that out of 449 patients undergoing chemotherapy for various cancers, 86% reported at least one side effect. Fatigue was the most common side effect overall (85%), followed by diarrhea (74%) and constipation (74%).

We understand that going through the stem cell transplant can be difficult. That’s why on days that you feel well, Dr. Costello recommends that you seize the day. “Some days you’re just gonna feel like staying in bed curled up in a ball. Some days you may feel like it’s a good day, and I tell people to take advantage of those days and get up and move around.”

High dose chemotherapy allows your body to hit the reset button. As Dr. Costello puts it, “It’s a way to start anew, to start afresh. The next steps are just letting those stem-cells get in there, get comfortable, and start growing.”

Fortunately, the short term side effects don’t last forever. Patients can expect to be out of the hospital within two to three weeks following the stem cell transplant.

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