Stem Cell Transplantation
Once your doctor determines that a stem cell transplant is your best option, ask about the process and what to expect. It is an intense treatment and requires the necessary support of a caregiver. Learn as much as you can, including the potential risks and benefits, before proceeding.
The goal of stem cell transplantation is to create a new immune system by helping restore the body’s ability to produce blood stem cells. The soft, spongy tissue inside your bones that is bone marrow produces blood-forming stem cells. They make billions of white blood cells that fight infection and illness, red blood cells that deliver oxygen to your body’s cells, and platelets that help your blood clot to stop bleeding.
High doses of chemotherapy are used to destroy the cancer cells in the marrow, blood and other parts of the body. A stem cell transplant, in which a person receives healthy stem cells (blood-forming cells) to replace their own stem cells that were destroyed by treatment with radiation or chemotherapy, is then performed. A successful procedure results in healthy bone marrow and restores the body’s immune response.
Two main types of blood stem cell transplant are available. The most commonly used to treat multiple myeloma is an autologous (auto) transplant. It uses your own stem cells. If needed, you will receive another transplant 6 to 12 months later, which is called a tandem stem cell transplant.
An allogeneic transplant may be used in some cases. It uses donated stem cells that come either from a family member or someone not related to you — often found through a registry (see Lifesaving donors needed below). Along with replacing stem cells, the donated cells may also kill cancer cells that remain after high-dose conditioning. This is called the graft-versus-tumor effect.
Donor tissue needs to match yours as closely as possible. A close match reduces the chance of a serious condition known as Graft-versus-Host Disease (GvHD). A type of white blood cell called a T-cell triggers this reaction.
The Transplant Process
Stem cell transplants generally occur as follows:
- Collection. Stem cells from you or a donor are collected, filtered and processed. In some cases, the cells are frozen and stored, and later thawed.
- Conditioning. You may receive high-dose chemotherapy or full-body radiation therapy to destroy the cancer cells. Reduced-intensity conditioning treatment that uses milder doses of chemotherapy and radiation therapy may also be an option in an allogeneic transplant. The potential success of this approach depends entirely on the anti-cancer effect of the new immune system transplanted into the patient.
- Transfusion. A doctor infuses the harvested stem cells into your body through a vein.
- Recovery and engraftment. Within about 2 to 4 weeks, healthy cells begin to grow (engraft). While your weakened immune system recovers, you will be at risk for infection. This process will require ongoing use of prophylactic (preventive) antiviral and antibacterial medications as well as repeat inoculations with childhood vaccines. The number of red blood cells, white blood cells and platelets will continue to be monitored until they are back to safe levels. Allogeneic transplant recipients also remain at risk for chronic GvHD and may require lifelong treatment for this condition.
Surround Yourself With Support
This treatment option takes time and effort. You will benefit from the help of a caregiver pre- and post-transplant. If a loved one or friend is not available, consider hiring a temporary caregiver to help with these and other tasks:
- Deep clean the home before you return.
- Keep your home clean and safe to help protect you from infection.
- Schedule and take you for appointments and immunizations.
- Ensure you stay on schedule with your treatments.
- Care for your dressings or central venous catheter, and deliver medicines through the catheter, if applicable.
- Check for signs of infection or other problems, and report changes to your medical team.
- Make healthy meals and encourage you to eat well.
- Help you access resources to help with the psychosocial, physical and financial challenges of a transplant.
Understanding Graft-Versus-Host Disease
Graft-versus-Host Disease (GvHD) is a potentially serious condition that occurs when graft immune cells from a donor in an allogeneic bone marrow transplant recognize the patient’s own healthy cells as foreign and attack them. GvHD can damage your skin, liver, intestines and other organs.
GvHD can be mild, moderate or severe. If it emerges within 100 days of the transplant, it is usually classified as acute. Chronic GvHD usually appears later after the transplant and may cause short-term or long-term symptoms. Your doctor may prescribe a preventive drug that helps minimize the risk of acute GvHD.
If you experience any of the following symptoms that signal the onset of GvHD after your transplant, contact your doctor immediately:
- Abdominal pain and swelling or diarrhea
- Rashes, raised or discolored skin, skin thickening or tightening
- Yellow skin or eyes, dry eyes
- Taste changes or loss of appetite
- Frequent infections, unintentional weight loss
- Indigestion, abnormal gas or bloating