Stem Cell Transplant for Multiple Myeloma – What to Expect

But before patients are even ready to receive a high dosage of chemotherapy, a long process of preparation is required. Physicians extract healthy stem cells from your bone marrow, but they cannot do so initially since cancerous myeloma cells clog the bone marrow, making them unreachable. Thus, to free up the stem cells for extraction, patients must first undergo about four rounds of standard dose chemotherapy lasting four months in total. By the fourth month, approximately 90% of patients have cleared away the cancer cells enough to begin the process of stem cell extraction.

After the fourth month of standard dose chemotherapy, patients take growth factors via injection that stimulate the stem cells in the bone marrow to move into the blood. Then these stem cells are collected from the patients blood via a blood draw. This process typically takes about 7-10 days.

Following collection of stem cells, patients come into the clinic and are given the high dose chemotherapy, Alkeran, via intravenous fluid. High dose Alkeran is most effective in killing the most myeloma cells, but because of its high dosage, it also eliminates many of your body's healthy cells in the bone marrow, such as those that eventually create red blood cells and white blood cells. The elimination of these important blood cells during the transplant can put the patient at risk for infection and bleeding. As a result, patients must be pre-screened for eligibility to handle the treatment. Oncologists typically do not allow transplant for individuals over age 65 or those who have had major major health problems, such as serious heart, lung, liver, or kidney disease.

The timeline for treatment, starting with high dose Alkeran, is as follows:

• Day Minus One–This is the term oncologists use to denote the day that patients receive high-dosage of chemotherapy.
• Day Zero–patients are given a blood transfusion of their own stem cells.
• Day Three–the blood counts of patients can reach nearly zero. There is typically a delay from when high dose chemotherapy is administered to when the toxic effects are seen in the body. So widespread low blood cell counts are not measured until four days after chemotherapy
• Day 7-10–patients blood counts are back to normal. Similarly to chemotherapy, there is a delay from when the stem-cell transplant is infused until its positive effects are seen in the body. So blood counts do not reach normal levels until then. Patients' blood counts are monitored until then and they are given extra blood transfusions if needed.
• After Day 10–at this juncture patients are, according to Dr. Vincent Rajkumar, medical oncologist at the Mayo Clinic, "end-graft." In other words, "new bone marrow starts forming, new blood cells come out, and the myeloma has been taken care of. "

Starting with collection of stem cells and ending with full recovery, stem cell transplantation spans about 2-3 weeks, depending on how long it takes for patients to recover. Dr. Rajkumar summarized the process of receiving chemotherapy followed by transplant: "There is no surgery involved. It’s basically like giving an IV medication for a day or two, and then giving a blood transfusion. That’s all that’s involved."

(For more on stem cell transplant)

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