Stem Cell Transplantation for Multiple Myeloma

Stem cells are immature blood cells that reside in bone marrow and develop into red blood cells, which provide oxygen to tissue, and white blood cells, which fight infection. Stem cells can also become platelets, which help with blood clotting.

A stem cell transplant involves replacing your damaged bone marrow with healthy stem cells after you receive high-dose chemotherapy, or drugs that help to destroy cancer cells throughout the body. High-dose chemotherapy can be an effective way of killing the cancerous plasma cells of multiple myeloma, but it also destroys healthy bone marrow, which is critical in producing the cells needed for proper blood and immune system function.

High-dose chemotherapy with stem cell transplantation can be performed immediately after the induction phase of medical therapy, if the cancer does not respond well to initial treatment.

At NYU Langone, doctors may delay the procedure if multiple myeloma has responded well to other therapies. Stem cell transplantation can still be beneficial later in the course of the cancer, when symptoms may worsen and other therapies may no longer be useful.

Whether a transplant is performed immediately or delayed, people with multiple myeloma usually undergo stem cell collection so they can prepare for autologous stem cell transplantation. An autologous transplant uses stem cells taken from your own body instead of from a donor.

Stem cell collection involves taking stem cells from your bloodstream. Before collection, doctors may give you medications that cause stem cells to leave the bone marrow and circulate in the blood.

Some blood is then removed from the body through a catheter, or hollow tube, connected to a machine that filters out the stem cells. The remaining parts of the blood are infused back into the body.

Collection takes several hours per day, for three to five days, and usually occurs after completion of the first few months of medical therapy for multiple myeloma, or the induction phase. Collected stem cells are placed in frozen storage.

An autologous stem cell transplant is considered a standard of care in the treatment of people with multiple myeloma and is performed routinely at NYU Langone.

After high-dose chemotherapy, or the consolidation phase of treatment, is complete, your own stem cells are taken from frozen storage, thawed, and put back, or reinfused, into your body through a catheter to help restore the bone marrow and the production of red and white blood cells and platelets. Reinfusion takes several hours.

The decision to perform an autologous stem cell transplant is complex. Doctors consider the characteristics of multiple myeloma, as determined during diagnostic tests, that predict the response of the disease to induction therapy. Some people with multiple myeloma undergo more than one stem cell transplant to manage their condition over time.

Allogeneic stem cell transplantation usually occurs only as part of a clinical trial, because it is not a standard of care for multiple myeloma. This approach uses stem cells from a donor—usually a close blood relative or someone whose blood and tissue types match yours.

The benefit of this form of transplantation is that the donor stem cells can cause a new immune system to develop, which may help kill remaining cancerous plasma cells. This sometimes leads to remission, meaning no signs of cancer can be detected in the body.

It also carries more risk than autologous transplantation. The new immune system may recognize your own body as foreign, creating an unhealthy immune response. For this reason, your doctor may use an allogeneic stem cell transplant only if insufficient stem cells can be collected from your body for an autologous procedure or the cancer does not respond to other treatments.

After the healthy stem cells are in your body, they travel through the bloodstream to the bone marrow, where, over time, they begin to make new blood cells.

The high-dose chemotherapy you received can cause your blood cell levels to fall for the first few days after a transplant, making you vulnerable to infection and bleeding. During this time, doctors closely monitor you in a special isolation room, where you may receive antibiotics to prevent infection and transfusions of red blood cells and platelets to manage bleeding. During the next 10 to 14 days, the stem cells start producing new blood cells again, a process called engraftment. Most people stay in the hospital during this time for monitoring.

After blood cell levels return to normal and your doctors determine you are well enough, you can go home. Frequent follow-up appointments are needed, because your immune system may be weak for three or four months.

NYU Langone offers a number of physical and psychological support services for people who have undergone stem cell transplantation, to help throughout the recovery process.

NYU Langone conducts clinical trials that seek to find out how stem cell transplantation can become more effective while causing fewer side effects. Your doctor can help you determine whether a traditional or more experimental approach to transplantation is best for you.