Published on September 24, 2020
Is a Stem Cell Transplant Necessary for Multiple Myeloma?
Jack Aiello, a Patient Power host and patient advocate, has been living with multiple myeloma since 1995. He has had three stem cell transplants.
Jack led a recent Patient Power discussion with Dr. Amrita Krishnan, director of the Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope, and Steve Albano, a multiple myeloma patient who has also undergone the procedure. These are highlights from their conversation.
What is Multiple Myeloma?
Multiple myeloma is a cancer of the plasma cells, a type of white blood cell in your bone marrow. It can cause infections, bone lesions and immune system dysfunction. According to the American Cancer Society, about 32,270 new cases of multiple myeloma will be diagnosed in the United States this year.
What Is a Stem Cell Transplant?
There are two types of stem cell transplants: autologous (using the patient’s own cells) and allogeneic (using cells from a donor). During this process, stem cells, which generate all other specialized cells, are taken from either the bone marrow or the bloodstream. They are frozen and stored while the patient undergoes high doses of chemotherapy, or other intense treatments, and then transplanted back into the patient’s body, where they generate new, healthy cells.
Because a stem cell transplant involves taking the patient’s immune system down to zero and slowly bringing it back to a normal range, cancer patients have to wait until they are healthy enough to have the procedure. This can mean waiting days, weeks or even months.
A Myeloma Patient’s Perspective
In 2011, Steve Albano began noticing shortness of breath and fatigue that led him to his doctor’s office. Standard blood tests showed that he was anemic, meaning his blood didn’t have enough healthy red blood cells. He also had two cracked ribs. Follow-up tests revealed a diagnosis of multiple myeloma.
While bone issues like fractures and bone pain are common in multiple myeloma patients, Steve was spared most of the bone issues associated with the disease. And first-line chemotherapy brought his multiple myeloma numbers down but not enough to put him into remission.
“My doctors recommended a stem cell transplant and I had that done at Stanford University in January 2013,” Steve said.
“That worked very well for me and I’ve remained in remission since then,” he added.
Who Should Have a Stem Cell Transplant?
“Patients who haven’t gone into a complete remission after fairly intense initial therapy [should consider a stem cell transplant],” said Dr. Krishnan, a leader in the field and director of one of the largest transplant centers in the United States. “We feel that transplant would give you that opportunity to get into a deeper response.”
Dr. Krishnan also believes that patients with high-risk multiple myeloma should consider a transplant.
“We feel that more intensive therapy beyond standard induction therapy will give them a better chance of staying in remission.”
For those considering stem cell therapy, having a series of consultations with the transplant team can help patients decide what is best for them.
In another Patient Power interview, Professor Charles Craddock of the Queen Elizabeth University, Birmingham, explained the importance of having multiple consultations with a specialist before deciding to undergo a stem cell transplant.
“At the first meeting, we would talk about the treatment options available in their disease, which might, for example, be chemotherapy or a transplant or to do nothing. And one can talk through the benefits and risks of that,” Professor Craddock said.
As always, talk to your doctor to get the care that’s right for you.
Is Age a Factor in Determining Transplant Eligibility?
Clinicians look at physiological age, not just date of birth, to determine whether a patient is eligible for a transplant, Dr. Krishnan explained. She also referenced a study from MD Anderson Cancer Center in Houston, Texas.
“Older patients tend to have a couple more days in the hospital, but the infection rate, everything else is really basically the same,” Dr. Krishnan said. “There's been data even from MD Anderson, looking at transplants and patients up to the age of 80. So, clearly, that age limit really is going, is gone, away,” she said.
What to Expect During Transplant Recovery
From Dr. Krishnan’s perspective, patients who can go home the day of the procedure have lower infection rates, sleep better in their own beds, and have better mobility than those who stay in the hospital.
Steve experienced a lack of appetite during recovery which led to weight loss. For some, this may be okay, but for others, it may not. Talk to your doctor about any side effects or unusual changes. Within a month, Steve was regaining his appetite and soon after that returned to work.
Was the stem cell transplant a success? For Steve, it was.
Dr. Krishnan cautions patients that they may not see immediate results.
“It can take up to three months to see the full benefit of transplant,” she said.
Can Transplant Patients Get Vaccines?
Dr. Krishan said she generally has patients wait four to six months before getting any vaccines because it’s not clear how soon the immune system gets back to normal after a stem cell transplant. The COVID-19 vaccine, when available, will be a dead vaccine. This means it will be absent of any live virus, which is optimal for patients who have received a transplant.
Deciding whether to undergo a stem cell transplant is a big decision and specific to each patient. It is best decided with your medical team, after weighing and discussing all of the options.
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