Stem cell transplant for myeloma

A stem cell transplant allows you to have high doses of chemotherapy. The chemotherapy kills the myeloma cells. But it also damages the normal bone marrow cells.

After the chemotherapy, you have new stem cells into your bloodstream through a drip. The cells find their way back to your bone marrow. Your body then starts making blood cells again and your bone marrow slowly recovers. 

Stem cell transplants are sometimes called stem cell rescue or intensive treatments.

When do you have a stem cell transplant for myeloma?

Your first treatment for myeloma is usually a combination of targeted cancer drugs, chemotherapy and steroids. This aims to destroy as many myeloma cells as possible. You have treatment for 4 to 6 months.

After you complete this initial treatment, you might have a stem cell transplant. This is a very intensive treatment, and can cause severe side effects. So you need to be well enough. They are not suitable for everyone. Your specialist will talk through the options with you. 

You have high doses of chemotherapy to kill any remaining myeloma cells. You then have new stem cells into your bloodstream through a drip. These stem cells ‘rescue’ the bone marrow. This allows the bone marrow to recover and blood cell production to continue.

What are stem cells?

Stem cells are very early cells made in the bone marrow. Bone marrow is a spongy material that fills the bones.

These stem cells develop into 3 different types of blood cells. They are:

• red blood cells - contain haemoglobin and carry oxygen around the body
• white blood cells - part of your immune system and help fight infections
• platelets - help clot the blood and stop bleeding

What is a stem cell transplant?

A stem cell transplant uses stem cells from the bloodstream. This is also called a peripheral blood stem cell transplant (PBSCT). This is different to a bone marrow transplant. A bone marrow transplant uses stem cells directly from the bone marrow.

Stem cell transplants are the most common type of transplant. Doctors don't often use bone marrow transplants any more. 

For myeloma, you usually have a transplant using your own stem cells. This is called an autologous transplant or auto transplant. Rarely, you have a transplant using stem cells from a donor. This is called an allogenic transplant, or allograft.

Collecting your stem cells

You have injections of growth factors before stem cell collection. Growth factors are natural proteins that make the bone marrow produce blood cells. You have them as small injections under the skin.

You have daily injections of growth factor for between 5 and 10 days. Sometimes you might have low doses of chemotherapy with the growth factor injections.

On the collection day

After your growth factor injections, you have blood tests every day to see if there are enough stem cells in your bloodstream. When there are enough cells, your nurse collects them. This is called harvesting.

Collecting the stem cells takes 3 or 4 hours. You are awake during this process. You lie down on a couch. Your nurse puts a drip into each of your arms and attaches it to a machine.

Your blood passes out of one drip. It goes through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood. They are collected and frozen until after your high dose treatment.

Side effects

You might feel very tired after having your stem cell collection. You might have:

• tingling around your mouth
• muscle cramps

This happens if your calcium level gets low during your collection. You may have extra calcium through a drip if this happens.

Having a stem cell transplant

Having high dose (intensive) treatment

You have a stem cell transplant after high dose chemotherapy. You usually have a drug called melphalan.

You have your high dose chemotherapy through a central line. This type of line runs up under your skin to a large vein close to your collarbone.

You can have anti sickness medicines and antibiotics through your central line too. And your nurses can take blood samples from your line.

Having the stem cells

Around a day after high dose chemotherapy, you have your stem cells back through a drip. 

The cells flow through your central line into your bloodstream. You might need another small plastic tube in your vein called a cannula, if the cells don't flow easily.

You are awake while you have the drip. It's like having a blood transfusion. It usually takes a couple of hours at the most.

Having stem cells from a donor

Rarely, you might have a stem cell transplant using cells from a donor. This is called an allogeneic transplant. This isn't a common type of transplant for myeloma.

Ideally, your donated stem cells need to match your own. A brother or sister is most likely to be a close match.

Sometimes, if you don't have a brother or sister who is a match, you can have stem cells from a donor. This could be a donor who is not related to you but whose stem cells are similar to yours. This is called a matched unrelated donor (MUD) transplant.  

Side effects

The possible side effects of a stem cell transplant are caused by high dose treatment. The treatment lowers the number of the different blood cells. Side effects include:

• low blood cell counts, causing an increased risk of infection, bleeding and bruising, and anaemia
• sickness, diarrhoea or constipation 
• a sore mouth, indigestion, loss of appetite, weight loss
• tiredness (fatigue)
• reduced concentration
• hair thinning or hair loss

Some side effects start to get better within a few weeks of your transplant, others can last for much longer, such as fatigue.

If you have stem cells from a donor, there is a risk of them attacking some of your own body cells. This is called graft versus host disease (GvHD).It is rare to have stem cells from a donor as a treatment for myeloma.

How long will I be in hospital?

After high dose chemotherapy, you have low numbers of blood cells for some time. This means you are at risk of picking up infections.

You may stay in hospital until:

• your blood cells have recovered enough to go home
• you no longer have any severe side effects 

This may take 3 to 4 weeks, although it can vary from one person to another. 

Some people become outpatients straight after their stem cell transplant. So you might go home or stay in a hotel near the hospital.  You need to attend the hospital daily for blood tests and treatment. You only stay in hospital if you develop complications.