In the past few years, the number of treatment options for multiple myeloma has grown quickly. Initial treatment options include chemotherapy and targeted therapy. Chemotherapy works by killing or slowing down the growth of cancerous cells. Targeted therapy works by blocking the growth and spread of cancer cells by disrupting specific parts of the cells. If the disease is controlled with initial treatment and the patient is healthy enough, many patients will then have an autologous transplant.
In an autologous bone marrow transplant, blood-forming cells are collected from the patient's blood stream and frozen. This process is called apheresis. Later, the patient then gets a very high dose of chemotherapy. This chemotherapy is called a conditioning regimen or preparative regimen. The goal of the preparative regimen is to kill as many cancerous cells in the body as possible.
The preparative regimen also destroys most of the normal cells in the patient's bone marrow. To restore the marrow, the patient's frozen blood-forming cells are thawed and infused into the blood stream. From there, the cells find their way into the bone marrow where they start making healthy white blood cells (including plasma cells), red blood cells, and platelets.
Although an autologous transplant can get rid of many of the cancerous plasma cells, the disease will almost always return. When the disease returns it is called a relapse. Some patients may keep getting treatment after an autologous transplant called maintenance treatment. Maintenance treatment is given to slow down relapse. Many patients who have received an autologous transplant can have a good quality of life for many years.
For some people, after the first autologous transplant, no more transplants are planned until the disease relapses. For others, depending on a variety of factors, the transplant doctor may recommend another transplant before the disease relapses. The second transplant may be another autologous transplant or an allogeneic transplant. When a patient has two transplants planned within one year, it is called a tandem transplant.
An allogeneic bone marrow transplant also begins with chemotherapy (preparative regimen). This type of transplant uses healthy blood-forming cells from another source. This source can be a family member, an unrelated donor, or an umbilical cord blood unit, which is collected after a baby is born.
After the preparative regimen is given, the blood-forming cells from the donor are infused into the patient's blood stream. From there, the cells find their way into the bone marrow, where they start making healthy white blood cells, red blood cells, and platelets.
Understanding if transplant would help your multiple myeloma
Whether an autologous or allogeneic transplant is right for you depends on several things, such as your age, overall health, stage of the disease, and how fast the disease is growing. A transplant doctor will discuss the risks and benefits of each type of transplant with you.
There are medical guidelines for when someone should be referred for a transplant consultation, whether or not or not you might need a transplant at that time.2 Talking to a transplant doctor is recommended:
- After starting therapy (soon after you get a first treatment)
- At the first sign the disease is getting worse
2. Recommended Timing for Transplant Consultation. Guidelines developed jointly by National Marrow Donor Program/Be The Match and the American Society for Blood and Marrow Transplantation (ASBMT). Available at: BeTheMatchClinical.org