What to Expect After a Stem Cell Transplant

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Topics include: Treatments

You’ve successfully completed a stem cell transplant as part of your myeloma treatment but what’s next? Myeloma experts Dr. Faith Davies and Dr. Robert Orlowski discuss what to expect after a stem cell transplant, including maintenance therapy and potential complications.

Sponsored by Patient Empowerment Network through educational grants from Onyx Pharmaceuticals, Novartis, and Millennium: The Takeda Oncology Company.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Jack Aiello:

This person asks, after an allogeneic transplant, and that’s a transplant where you have donor stem cells being given to you as opposed to using your own stem cells, after an allogeneic transplant, is maintenance therapy needed? If so, how quickly after do you begin treatment? And I would say could you answer this for autologous transplant as well? So first allogeneic, would you do maintenance after an allogeneic transplant?

Dr. Davies:

Okay. So after you’ve had a transplant from a brother, or a sister, or an unknown, unrelated donor, the important thing is trying to balance what they call the graft-versus-myeloma effect, so that’s the effect of the immune system on trying to make the new donor cells grow, against what we call the graft-versus-host effect.

Which are some of the side effects that can occur with an allogeneic transplant. And so often after an allogeneic transplant, patients don’t get any form of maintenance, because there’s always a concern that you might actually aggravate the graft-versus-host disease and make things worse.

There was a study done in Holland a wee while ago where they actually very sensibly gave patients lenalidomide (Revlimid®), because they thought lenalidomide boosts the immune system. And it might actually make things better after an allogeneic transplant. And actually what they found was that those patients actually had rip-roaring GVHD. And it essentially overactivated the immune system. So there’s tended to be a step back in the allogeneic world. Most patients who’ve had an allogeneic transplant will have gone into a clinical study to have that.

And so there are some clinical studies looking at how we can manipulate the immune system in a more intelligent way, I guess, to try and get the benefit of both. But I think those are early days.

Jack Aiello:

And then after an auto transplant where maintenance may be recommended, is it recommended to start a certain timeframe after that transplant, or is it an open window?

Dr. Orlowski:

Well, after an autologous transplant, the typical standard is to recommend maintenance, because, unfortunately, there’s usually some myeloma left, and there’s usually no graft-versus-myeloma or graft-versus-host effect to worry about as in an allo [allogeneic transplant], as Dr. Davies mentioned.

Most of the trials that have looked at maintenance started at around 90 to 100 days after transplant, but you have to individualize that because some people may not have recovered fully from the effects of their transplant by 90 to 100 days. And starting it later may be necessary in those patients.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on February 3, 2015