How it Works

Allogenic transplant. Stem cells for an allogenic transplant come from another person, called a donor. Sometimes, cancer is treated with a high-dose, intensive chemotherapy or radiation therapy treatment. After chemotherapy, the donor cells are returned to your body, restoring your immune system and your body's ability to produce blood cells and fight infection.

Step 1: Donor identification. A matched donor must be found before the ALLO transplant process can begin. Your HLA type will be found through blood testing. Then, your healthcare team will work with you to do HLA testing on potential donors in your family and, if needed, to search a volunteer registry of unrelated donors.

Step 2: Collecting stem cells from your donor. Your healthcare team will collect cells from either your donor’s blood or bone marrow. If the cells are coming from the bloodstream, your donor will get daily injections (shots) of a medication to increase white cells in their blood for a few days before the collection. Then, the stem cells are collected from their bloodstream. If the cells are coming from bone marrow, your donor has a procedure called a bone marrow harvest in a hospital's operating room.

Step 3: Pre-transplant treatment. This step takes 5 to 7 days. You will get chemotherapy, with or without radiation therapy, to prepare your body to receive the donor's cells.

Step 4: Getting the donor cells. This step is your transplant day. Your health care team puts, or infuses, the donor’s stem cells into your bloodstream through the catheter. Getting the donor cells usually takes less than an hour.

Step 5: Recovery. During your initial recovery, you will get antibiotics to reduce your risk of infection and other drugs, including medications to prevent and/or manage GVHD. Your healthcare team will also treat any side effects from the transplant. Read more details below about bone marrow transplant recovery.

Often, a small tube may be placed in the patient's chest that remains through the transplant process. It is called a catheter. Your healthcare team can give you chemotherapy, other medications, and blood transfusions through a catheter. A catheter greatly reduces the number of needles used in the skin since patients will need regular blood tests and other treatments during a transplant.

Please note that transplants are complex medical procedures and sometimes certain steps may happen in a different order or on a different timetable to personalize your specific care. Ask your health care whether you will need to be in the hospital for different steps, and if so, how long. Always talk with your healthcare team about what to expect before, during, and after your transplant.

---

What Should I Know About A Stem Cell Transplant

Living with Multiple Myeloma is a continuous journey. A stem cell transplant is often used to treat myeloma. It is considered a safe and effective treatment for many patients. The stem cell transplant process spans several months and involves a series of appointments including: pre-transplant evaluation, extensive medical & lab tests, catheter or port placement, stem cell harvest, conditioning chemotherapy, stem cell infusion, and follow-up visits. The process can be both emotionally and physically challenging.

This guide is meant to complement the educational materials patients receive from their transplant team. It is intended to provide insight into the stem cell transplant process and help patients make educated and informed treatment decisions.

Where to begin – get organized!

Use a daily planner or wall calendar to keep track of pre-transplant appointments, follow-up visits & medication schedules.

• Get a notebook or journal to bring to medical appointments with questions or concerns. For post-transplant appointments, jot down your symptoms or any changes in how you feel.
• Patients should find a family member or friend who can accompany them to medical appointments to take notes and provide emotional support.
• Create a patient portal account with the hospital or transplant treatment center. This allows patients to secure access to their medical information and to message their healthcare team for non-urgent matters.
• Join the HealthTree Stem Cell Transplant Chapter for more information.
• Join HealthTree's social media stem cell transplant Connect group, where you can ask questions and read other patients' experiences.

Select a myeloma specialist and transplant treatment center

Research has shown that individuals with myeloma who are seen by a myeloma specialist live longer. A comprehensive list of myeloma specialists can be found on HealthTree's website.

A stem cell transplant involves specialized care and is only offered at certain hospitals or large cancer centers. Talk with a myeloma specialist about which transplant facility they recommend or are affiliated with.

Here are some guidelines for choosing a transplant center:

• Geographic location and commute – consider choosing a facility that is close to home.
• Treatment options – Inpatient vs Outpatient.
• Will the patient’s insurance cover medical expenses at this facility? Ask the healthcare insurance company about a dedicated case manager.
• Inquire about treatment center outcomes – how many transplants has the center performed for patients with multiple myeloma?
• What type of support services are offered for patients and caregivers?
• Explore available clinical trials.
• Get a second opinion if necessary.
• Connect with a coach/mentor who has undergone a stem cell transplant. They can provide support and a better understanding of the process from a patient’s perspective.

Before starting treatment, patients and their caregivers should meet with a financial counselor at the facility where they will be treated. The counselor will help determine coverage and estimate out-of-pocket costs. There may be restrictions on treatment options covered by Medicare and Medicaid.

---

The Most Common Side Effects of a Stem Cell Transplant Include:

You’ve probably already learned to deal with the side effects experienced during your induction therapy. Now it’s time to go through a stem cell transplant where the side effects from a high dose of Melphalan can be much more far reaching and severe compared to what you’ve experienced so far. It can be helpful to know what you might expect and what solutions your transplant team recommends to help mitigate them. Remember your transplant team has most likely gone through this with hundreds of patients and they have learned ways to help lessen side effects. They should be the first people you talk to about any discomfort you have, no matter how minor it may seem.

Although some patients experience some side effects from the Melphalan immediately, most don’t have any for a few days after infusion. More severe side effects typically happen about 10 days after treatment. Severity of side effects usually diminishes over the first several weeks after your stem cell transplant.

This is not a comprehensive list of Melphalan side effects, but these are typically the most common ones experienced during the first 100 days post-transplant.

• Fatigue – eat protein to increase energy, daily movement, nap as needed, blood transfusions may be required if hemoglobin is low
• Hair loss – see details in our section on Dealing with Hair Loss (link to Dealing with Hair Loss page)
• Nausea/vomiting- avoid spicy, fatty, fried and sweet foods, your doctor will prescribe medications to help manage this, communicate to nurse if you can’t keep anything down for 24-hours
• Mouth sores “Mucositis”- gargle with a solution of salt and baking soda or get a prescription for Magic Mouthwash
• Diarrhea – discuss with your nurse before starting any over the counter medicine, have adult diapers available if needed, eat frequent small meals, drink plenty of fluids limiting caffeine
• Neuropathy – discuss with your doctor, depending on severity, they may try another medicine
• Anemia – this is not unusual at any phase of this disease, partner with your doctor if this is severe
• Neutropenia – your lowest white blood count usually happens within two weeks of the transplant, follow a neutropenic diet, your nurses may give you booster shots to help increase your white blood count ( lint to Diet page)
• Insomnia – often caused by steroids, try to take them first thing in the am and not nap that day, partner with your doctor if it is severe
• Joint & bone pain – most MM patients deal with some level of pain throughout their journey, partner with your doctor on which medication you should take based on the severity of pain. He/she may also refer you to an orthopedic doctor if you have incurred spinal compression fractures or other bone injuries
• Decrease in appetite – chemotherapy can make your mouth taste bad and any food you eat have a metal tinge to it. Try small portions throughout the day of whatever sounds and smells good to you.

Follow Up Testing

100 days post-transplant is when your specialist will order a full round of follow-up tests. This typically includes bone biopsy, 24-hour urine test, skeletal survey or CT scans and blood work. These results will show what impact the stem cell transplant has had on lowering your cancer markers. Depending on your results your specialist may recommend you go on maintenance therapy. If you go back on an iMiD (like Revlimid) and a steroid (like Dexamethasone) and possibly chemotherapy, you will continue to manage side effects.

The most common ones are:

• Ongoing fatigue – continue to increase your movement daily, nap as needed, try to get yourself on a regular sleep schedule
• Insomnia – see above
• Joint & Bone pain – see above
• Neuropathy – see above

HealthTree, understands that side effects are something multiple myeloma patients deal with every day and at different levels of severity. Because of this, patients are often researching ways to diminish or eliminate these side effects. All multiple myeloma patients are striving for a higher quality of life. In response to this need, HealthTree has created an interactive way for patients to both look up potential solutions and share things that have worked for them.

In the “Side Effect Solutions” section of HealthTree, you can search for a specific side effect to find solutions that others have found helpful. These solutions have been provided by patients just like you. You can also filter side effects by an individual drug or combination of drugs.

Visit the Side Effect Solutions Tool on HealthTree 

 

Stem Cell Transplant Complete Guide