If patients tolerate the first phase of treatment well, they will be offered the option to move onto the second phase of treatment: the stem-cell transplant. Like the first phase, the goal of the second phase of treatment is to eliminate as many cancerous cells from the bone marrow as possible, but through the use of a chemotherapy known as Alkeran (Melphalan).
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, such as those that eventually create red blood cells and white blood cells. As a result, patients must be pre-screened for eligibility for a stem-cell transplant that will be used to replenish their depleted cells following the treatment, otherwise the high dose chemotherapy is not given. Oncologists typically do not allow transplant for individuals over age 65 or those who have had major major health problems, such as serious heart, lung, liver, or kidney disease.
There are two types of stem-cell transplants typically used to treat diseases. The first is the 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. Currently, all patients who undergo stem-cell transplant are given an autologous transplant.
The second form of stem-cell transplant is the allogenic transplant. An allogenic transplant takes stem-cells from a healthy donor that closely matches your body’s cell type and may even be related to you. This transplant is promising because these new donor stem cells not only replenish your own stem-cell stores, but can actually help kill off cancer cells as well. However, new immune cells formed from the donor stem-cell transplant might detect your own tissues and organs as foreign and attack them instead, like they would an infection. This can have serious long-term consequences, and so allogenic transplant is currently only approved in clinical trials.
The chemotherapy and subsequent stem-cell transplant take about two weeks and can be difficult to tolerate. Due to the initial high dose of chemotherapy, you will have to endure hair loss, nausea, vomiting, diarrhea, and a 50% chance of infection that can be treated with antibiotics. Patients typically recover by the end of the third week and are released from the hospital.
“You may be wondering to yourself, ‘why would I do all this?’ ” explains Dr. Nina Shah, medical oncologist at UCSF. “We know that the people who got the transplant up-front, as a planned therapy, had their disease be in remission for 14 months longer than those who did not.”
Although 14 months may seem small, Dr. Shah advises patients to think critically about the benefits of the bone marrow transplant. “The longer that you’re in what we call remission, or stable-state of disease, the longer that you can have a better quality of life. Although it’s an investment in time and toxicity, it’s something worth thinking about because there is long-term benefit.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Nina Shah is a hematologist who specializes in the treatment of multiple myeloma, a type of cancer affecting the blood marrow. She treats patients at the Hematology and Blood and Marrow Transplant Clinic. Read More
If patients tolerate the first phase of treatment well, they will be offered the option to move onto the second phase of treatment: the stem-cell transplant. Like the first phase, the goal of the second phase of treatment is to eliminate as many cancerous cells from the bone marrow as possible, but through the use of a chemotherapy known as Alkeran (Melphalan).
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, such as those that eventually create red blood cells and white blood cells. As a result, patients must be pre-screened for eligibility for a stem-cell transplant that will be used to replenish their depleted cells following the treatment, otherwise the high dose chemotherapy is not given. Oncologists typically do not allow transplant for individuals over age 65 or those who have had major major health problems, such as serious heart, lung, liver, or kidney disease.
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There are two types of stem-cell transplants typically used to treat diseases. The first is the
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. Currently, all patients who undergo stem-cell transplant are given an autologous transplant.
The second form of stem-cell transplant is the allogenic transplant. An allogenic transplant takes stem-cells from a healthy donor that closely matches your body’s cell type and may even be related to you. This transplant is promising because these new donor stem cells not only replenish your own stem-cell stores, but can actually help kill off cancer cells as well. However, new immune cells formed from the donor stem-cell transplant might detect your own tissues and organs as foreign and attack them instead, like they would an infection. This can have serious long-term consequences, and so allogenic transplant is currently only approved in clinical trials.
The chemotherapy and subsequent stem-cell transplant take about two weeks and can be difficult to tolerate. Due to the initial high dose of chemotherapy, you will have to endure hair loss, nausea, vomiting, diarrhea, and a 50% chance of infection that can be treated with antibiotics. Patients typically recover by the end of the third week and are released from the hospital.
“You may be wondering to yourself, ‘why would I do all this?’ ” explains Dr. Nina Shah, medical oncologist at UCSF. “We know that the people who got the transplant up-front, as a planned therapy, had their disease be in remission for 14 months longer than those who did not.”
Although 14 months may seem small, Dr. Shah advises patients to think critically about the benefits of the bone marrow transplant. “The longer that you’re in what we call remission, or stable-state of disease, the longer that you can have a better quality of life. Although it’s an investment in time and toxicity, it’s something worth thinking about because there is long-term benefit.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Nina Shah is a hematologist who specializes in the treatment of multiple myeloma, a type of cancer affecting the blood marrow. She treats patients at the Hematology and Blood and Marrow Transplant Clinic. Read More
