[Music] what are the different types of stem cell transplants so there's two kinds of transponders Oh Natali this using patient's own stem cells and allergenic using stem cells from a donor sitala Ghassan the high-dose chemotherapy we give before the transplant as the way to control the disease allergen a transplants on the new immune system from the donor as the way to control the disease there's a third type of transplant called the Sinjin a transplant which we will cover more in depth in the allo transplant class these are transplants that are conducted with an identical twin and the source of stem cells can vary but typically for autologous stem cells we harvest them from the blood nowadays we call them peripheral blood stem cells and the idea what that transplant is we will be introducing high doses of chemotherapy and that is designed to eradicate large amounts of disease in the bone marrow but it's very nonspecific it also kills stem cells that live in the marrow we rescue patients after the chemotherapy with stem cell infusion with gen repopulate s' the bone marrow in the bone marrow grows back ala to make transplant works in a little bit different way we rely on intensity of chemo to kill myeloma but when we put in cells from another person you also inherit their immune system and that immune system starts developing in the recipients body and sees differences on the myeloma cells and recognizes them as foreign tissue and goes and attacks them we call that the graph versus myeloma effect and it can be very powerful they can eradicate myeloma even when chemotherapy doesn't work anymore however with allergenic transplants there's a lot more complications when you have the donor cells attacking the myeloma they attack the myeloma because it looks like the recipient it looks different to the donor cells but the rest of the host also looks different normal tissues can be attacked and we call that graft-versus-host disease that's the major complication and that can be very difficult to manage so a lo transplant are done in more selective cases in myeloma patients because of that complication autologous transplants are more commonly used in multiple myeloma that's based on a study showing that use of these procedures leads to deep remissions and patients which can be maintained over time although it's not curative it can extend the period of remission significantly in myeloma we tend to do more at all of this transference in fact we do over 8,000 transplants a year in the United States myeloma is the leading indication for autologous transplant [Music]