Multiple myeloma (MM)

Multiple myeloma (MM) is a cancer of the plasma cells. Plasma cells are a type of white blood cell that produce antibodies to help your body fight infections. In MM, your body produces unhealthy plasma cells that aren’t able to fight off infections. These cells also produce M proteins, which are abnormal antibodies that don’t function correctly. These proteins circulate in your blood and can pass through your kidney’s natural filters, which is why MM can lead to kidney damage and weakened bones.

A blood or marrow transplant (BMT), also called a bone marrow transplant or blood stem cell transplant, replaces unhealthy bone marrow with healthy blood-forming cells from a donor. There is currently no known cure for MM, but a transplant can delay MM from relapsing.

For MM, doctors can use 2 types of transplant:

• Autologous transplant uses the patient’s own blood-forming cells, which are collected and stored for later use. This is the most common type of transplant used to treat MM.
• Allogeneic transplant uses healthy blood-forming cells from a family member, unrelated donor, or umbilical cord blood.

Some patients with MM might be able to have a treatment called chimeric antigen receptor T-cell (CAR-T) therapy. CAR-T therapy is not a transplant. It's a type of immunotherapy that uses a patient's own T-cells. The T-cells are genetically modified in a lab so they find and kill cancer.

Although each person’s journey is unique, bone marrow transplantation for multiple myeloma typically follows a series of distinct phases. From the initial therapy to the infusion of donor cells and ongoing recovery, here’s how the transplant process generally works:

• Preparation: You’ll begin with chemotherapy (and sometimes radiation) to destroy the unhealthy marrow. This step, called conditioning therapy, makes room for new, healthy blood-forming cells.
• Transplant: Next, healthy donor cells are delivered through an intravenous (IV) catheter, often referred to as a stem cell infusion. These cells travel to the inside of your bones and begin producing new blood cells.
• Recovery: Full recovery can take several months to a year. From the start of conditioning to leaving the hospital can take weeks to months. You’ll then spend additional time recovering near the transplant center and at home. During this period, your transplant team carefully monitors you, helping prevent any side effects or complications.

If you’ve been diagnosed with multiple myeloma or an existing diagnosis is getting worse, you should see a transplant doctor right away.

Scheduling an appointment with a doctor to discuss your MM diagnosis is the first step for treatment. At your first appointment, the transplant doctor will:

• Review your medical history
• Talk with you about your MM treatment options
• Discuss the risks and benefits of BMT transplant
• Recommend the best time for you to get a transplant and prepare for treatment
• If an allogeneic transplant is needed, a donor search may be started even if you don’t need a transplant right away. This can help you get a transplant faster if it’s needed later.

Patients that come from ethnically diverse backgrounds will often have a harder time finding a matching bone marrow donor. This is because of genes called human leukocyte antigens (HLAs), which are the codes inside your body doctors use to help find a match. HLAs are inherited, which means it will be easier to find a match using a patient and donor that share the same ancestry.

Unfortunately, not all ethnicities are equally represented on the registry.

Learn more about the importance of diversity

Ask questions so you can best understand the treatment options available for your multiple myeloma. Questions you may want to ask include:

• What are my chances of entering long-term remission if I get a transplant? If I don’t get a transplant?
• What are the risks of waiting or trying other MM treatments before a transplant?
• Does my current health or age affect how well transplant might work for me?
• What are the possible side effects of a bone marrow or blood stem cell transplant? How can they be reduced?
• How might my quality of life change over time due to MM, with or without transplant?

Learn more about planning for transplant