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Intensive treatment for myeloma

Men and women discussing myeloma

This page is about stem cell transplants for myeloma. You can find the following information

 

A quick guide to what's on this page

Intensive treatment for myeloma

Some people with multiple myeloma have high dose chemotherapy. This intensive treatment is used to improve the chance of complete remission. Remission means that there is no sign of active disease in your body. Trials using high dose chemotherapy have shown good results, with long periods of remission and helps some people live longer. Your specialist will only offer you intensive treatment if you are fit enough to get through it.

The main reason for having this treatment is that it is likely to give you the longest period of good health, with your myeloma in complete remission. Your specialist may also suggest intensive treatment if your myeloma is causing troublesome symptoms. If you have already had chemotherapy and your myeloma has not responded, high dose treatment is unlikely to help you.

Intensive treatment will kill off all your healthy bone marrow cells as well as the myeloma cells. To replace the bone marrow cells, you usually have an infusion (drip) of stem cells from your own blood (peripheral blood stem cell rescue or autologous stem cell transplant). In some cases, you may have stem cells from someone else (allogeneic transplant).

There is detailed information about bone marrow and stem cell transplants in the cancer treatment section.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating myeloma section.

 

 

Why intensive treatment is given for myeloma

Some people with multiple myeloma have high dose chemotherapy, usually with the drug melphalan. Your doctor may recommend intensive treatment to improve the chance of getting a complete response, which may be 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. There is no evidence at the moment that this treatment is a cure, but research is ongoing.

This is an intensive treatment, so your specialist will only offer it 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. It is your fitness and general health that count, not your age in years. The main reason for having this treatment is that it is likely to give you the longest period of good health, with your myeloma in complete remission. Your specialist may also suggest it if your myeloma is causing troublesome symptoms.

If you have already had treatment and your myeloma has not responded, your specialist may not recommend high dose treatment. In this situation your doctor may suggest other treatment, such as chemotherapy and steroids to lower the number of myeloma cells.

 

What intensive treatment is

The intensive treatment kills off your healthy bone marrow cells as well as the myeloma cells. The bone marrow is the spongy substance inside your bones. It contains the cells from which all your blood cells are made. These are called stem cells. Stem cells in the blood (peripheral blood stem cells) can be collected and stored. 

After the high dose treatment you have a drip (transfusion) containing stem cells so that you can start making blood cells again. Doctors call this a stem cell transplant. You usually have stem cells from your own blood (peripheral blood stem cell rescue or autologous stem cell transplant). In some cases, you may have someone else's stem cells (allogeneic stem cell transplant).

The stem cells that you have by drip find their own way to the centre of your bones. They begin to make blood cells after a few days or weeks. This process is called engraftment.

Read about having a stem cell transplant.

 

Having your stem cells collected

If you are having a transplant with your own stem cells, you first have several days of injections with a growth factor, such as G-CSF (granulocyte colony stimulating factor). This encourages your bone marrow to make lots of stem cells which spill out into your blood. You may have chemotherapy, usually cyclophosphamide, before starting the injections. A specialist nurse or technician collects the stem cells from your blood. To do this, they use 2 tubes that are like drip (intravenous infusion) tubes to connect you to a machine. The machine is called a cell separator or apheresis machine.

collecting stem cells

Your blood goes out of one tube and into the machine. The machine takes out the stem cells and the rest of the blood is given back to you through the other tube. This process takes about 3 or 4 hours. The nurse or technician then freezes the stem cells, ready to be given back to you by drip after your high dose chemotherapy.

If not enough stem cells are collected, your doctor may use a drug called plerixafor together with the growth factor injections to help.

Read more about stem cell transplants.

 

Donor transplants

Allogeneic transplant means that the stem cells or bone marrow used for the transplant are from a donor. The donor's blood cells need to closely match your own. The most suitable donor is usually a close relative such as a brother or sister. In certain situations it may be possible to get a match from an unrelated donor. This is known as a matched unrelated donor (MUD). To ensure that the donor’s bone marrow matches your own, special blood tests will be carried out. This is called tissue typing. Allogeneic transplants are only suitable for younger patients because of the side effects and complications involved.

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Updated: 29 December 2015