What are the different types of stem cell transplants?

So there's two kinds of transplant. There is an autologous, using patient's own stem cells and allogeneic, using stem cells from a donor.

Autologous really counts on the high dose chemotherapy we give before the transplant as the way to control the disease.

Allogeneic transplant counts on the new immune system from the donor as the way to control the disease.

In myeloma, we tend to do more autologous transplants. In fact, we do over 8000 transplants a year in the United States.

Myeloma is the leading indication for autologous transplant.

So we had a great interest in allogeneic transplant actually dating back 20 years, because we really felt that that was the way to cure myeloma.

The problem is the initial allo transplants had very, very high risk. 50% of patients wouldn't survive because of complications, either infection or graft versus host disease.

We got better with time. We did something now called the Mini Allo. So using less intensive therapy and counting on the immune effects of the donor stem cells.

But even in that setting, about 18% of patients will not survive again, primarily because of this graft versus host disease.

So at the end of the day, the survival really seems to be the same. Using auto transplant or an allo.

And so we tend to prefer the allogeneic the autologous transplant and so we tend to prefer the allogeneic the autologous transplant because the risk is much lower.

Autologous transplants are more commonly used in multiple myeloma. And that's based on a study showing that use of these procedures leads to deep remissions in patients, which can be maintained over time.

Although it's not curative, it can extend the period of remission significantly.

So that's the most common type of transplant done in myeloma.

We rescue patients after the chemotherapy with stem cell infusions, which then repopulate the bone marrow and the bone marrow close back.

Allogeneic transplant works in a little bit different way. In the recipient's body and sees differences on the myeloma cells and recognizes them as foreign tissue and goes and attacks them.

We call that the graft versus myeloma effect. And it can be very powerful.

It can eradicate myeloma even when chemotherapy doesn't work anymore.

However, with allogeneic 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 donor cells offset.

The rest of the host also looks different.

So 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 allo transplants are done in more selective cases in myeloma patients because of that complication.

Almost everyone should consider an autologous stem cell transplant.

We can do autologous stem cell transplants on older patients.

Most myeloma patients that get diagnosed are in their sixties and seventies and age is not a barrier.

It's really how healthy you are and how fit you are and whether you want to do it.

So if you can walk into my office, you can have an autologous stem cell transplant. You're fit enough in my book.