Intensive treatment uses high dose chemotherapy followed by a stem cell transplant.
Why you might have intensive treatment
Your doctor may recommend intensive treatment to improve the chance of getting a complete response, which is called CR or remission. Remission means that there is no sign of active disease in your body. There have been good results using high dose chemotherapy in trials, with patients having long periods of remission and living longer.
Your specialist will only offer intensive treatment if you are fit enough to get through it. Generally, doctors are prepared to carry out high dose chemotherapy on people up to the age of 70. But this is only a guide.
What stem cells are
Bone marrow is a spongy material that fills the bones. It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.
What intensive treatment is
You have a stem cell transplant after very high doses of chemotherapy, usually melphalan. The chemotherapy has a good chance of killing the myeloma cells but it also kills the healthy stem cells in your bone marrow.
Before your high dose chemotherapy, your team collects your stem cells. Or in some cases, they collect a donor's stem cells. After the treatment you have the cells into a vein through a drip. The cells find their way back to your bone marrow. They begin to make the cells you need after a few days or weeks. This process is called engraftment.
Collecting your stem cells
You have injections of growth factors before, and sometimes after, the stem cell transplant. Growth factors are natural proteins that make the bone marrow produce blood cells.
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.
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. Your nurse will give you extra calcium through a drip if this happens.
Having stem cells from a donor
In some cases, you might have a stem cell transplant using cells from a donor. This is called an allogeneic transplant. The cells need to be as similar as possible to yours.
So these can be from:
- a brother or sister (a sibling match)
- someone not related to you but whose stem cells are similar to yours (matched unrelated donor)
The side effects of having a stem cell transplant are caused by high dose chemotherapy.
The main side effects include:
- low blood cell counts, causing an increased risk of infection, bleeding and anaemia
- sickness and diarrhoea
- a sore mouth
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).