[Music] what is an a SCT ornithologist stem-cell transplant why is it effective and is it safe an autologous stem cell transplant you know we call it by several different names one of the names is a peripheral blood stem cell transplant another name is a high-dose chemotherapy with stem cell support I like the term high-dose chemotherapy with stem cell support because that's what we actually do is a process in which we use a very high dose of chemotherapy that we normally cannot give to a person we use that to kill their bone marrow entirely which basically destroys the myeloma and the person's bone marrow and also their normal cells in the bone marrow so that if we gave it to a person without further stem cell support their bone marrow would never function and that would be fatal so what we actually do is collect stem cells which are mother cells or seed cells of the bone marrow from the person store them away in a freezer and then give them the high dose of chemotherapy which essentially achieves what we call Milo blasian which means destroys the bone marrow completely to both the myeloma cells and the normal cells get destroyed and then we use the stored frozen stem cells and infuse them back into the patient through their wings the cells know how to go back to the bone marrow they go there and over the course of the next two weeks they recover and the bone marrow works normally now hopefully rid of the myeloma cells stem cell transplant is a procedure whereby we collect blood or marrow stem cells from a patient put those in the freezer temporarily and have the patient come in to receive high-dose chemotherapy using a drug called alpha lent and then once the mouth line is cleared from the bloodstream we give the stem cells back to build up the blood count so this way patients can receive high-dose chemotherapy which hopefully will knock down or knock out their myeloma while allowing us to rescue their bone marrow the blood counts from the effects of the high-dose chemotherapy using the previously collected blood or marrow stem cells so this has been a time-honored treatment for multiple myeloma in fact all the treatments that have changed the course of history in myeloma patients this is one of the most important started coming in the late 1980s and it became very early established in the next two decades why does the talaga stem cell transplantation work in myeloma basically stem cell transplants work when you have a treatment that when it applied in a very high dose kills myeloma cells proportionally more so we have a drug called mal fall and it was probably the first ever chemotherapy that worked for myeloma well people found that there is a dose-response effect for mouth line you give a higher dose more cells get killed when we get up to the higher doses we find that mal flying destroys the normal cells in the bone marrow too much and then the bone marrow doesn't recover back to have normal function we need normal stem cells to rescue the person from that high dose of chemotherapy after we have given such chemotherapy do the attalos stem cells have any anti myeloma effect the cells that we give to the patient generally are not thought to do much although in some cases you could argue that they do have they do restore immune function and there's a little bit of an immune reboot that happens but the vast majority of the effect in an autologous stem cell transplant or an auto transplant which is the main transplant for myeloma happens from the high dose of chemotherapy that we use his transplant safe so high-dose melphalan and an autologous stem cell transplantation is very safe the likelihood of life-threatening complications is very low most centers would code you know value of 1% or less a third of the patients will have rate 3 or 4 toxicities these are non hematologic toxicities almost every patient will develop anti leukemia during the process and that vulnerability of high-dose melphalan has improved primarily because the supportive care that we provide to patients has improved over the last 25 30 years the safety of stem cell transplant is very high and nowadays is result of the ability to collect plenty of stem cells as well as advances in supportive care the likelihood of mortality or fatality from high-dose chemotherapy and autologous stem cell transplantation is less than 1% [Music]