Stem Cell Transplants and Myeloma

Stem cell transplant is still the single most effective treatment for multiple myeloma, yet 45% of patients are never given this therapy, according to Dr. Sergio Giralt of the Memorial Sloan Kettering Cancer Center. While transplant is not a fun process for patients it can be done successfully, even for older patients, if they are fit enough to undergo the procedure.

In a short video (below), Dr. Rafael Fonseca of the Mayo Clinic in Scottsdale explains the reasons why patients should receive a stem cell transplant and demystifies the process in detail. He tells us that transplant is a key tool in the management of myeloma and should be used as an up-front procedure because it adds time of disease control and extends the time to relapse. On average, patients who receive stem cell transplant can go 5-6 years before needing an additional major interventional therapy. For a small subset of patients, it could be the last intensive treatment they need. 

He outlines the steps to transplant for an in-patient stem cell transplant, though many centers also offer it as an out-patient procedure:

1. Testing
2. Gather stem cells
3. Physical exam
4. Picc line installation
5. Admission to hospital – chemo through IV – melphalan – anti-nausea medicine
6. Ice chips – reduce blood flow to lining of mouth. Reduces mouth sores.
7. Day after – rest day
8. Stem cells given back – bagged and infused. Practitioners are dressed in gowns to prevent infection.
9. How do cells get back to bone marrow? They have recpetors to know where to go.
10. Two weeks before they fully recover.
11. During that two weeks the old bone marrow dies and the new bone marrow grows.
12. First week most patients do pretty well. Some GI issues can happen.
13. Second week is harder with potential GI issues that will eventually resolve. Symptoms not uniform.
14. Counts have recovered. Eating and drinking fine.
15. Cells come back around day 12
16. White count low – if you have a fever, treat with antibiotics then ask questions later. Can just be bacteria passing through your body.
17. Low platelet count – can do a transfusion if needed. Low platelets aren't a major issue but something they monitor.
18. If you need red cell transfusion, it can be there too.
19. Stay away from crowds but visitors are fine.
20. After 2 months do assessment again.

We hope you enjoy this informative video by Dr. Fonseca about this key procedure in multiple myeloma.