Multiple myeloma is a type of cancer that originates in the plasma cells, white blood cells found primarily in the bone marrow. These abnormal plasma cells, known as myeloma cells, multiply uncontrollably, producing abnormal proteins and interfering with healthy blood cell production. Stem cell transplantation represents one significant approach among various available options. This article explores its role and considerations in multiple myeloma treatment.
What a Stem Cell Transplant Involves
An autologous stem cell transplant, the most common type for multiple myeloma, involves several distinct phases. The process begins with collecting a patient’s own healthy blood-forming stem cells, typically from the bloodstream via apheresis. This is usually done after medication encourages stem cells to move from the bone marrow into the circulating blood.
Following collection, patients undergo high-dose chemotherapy, known as myeloablative therapy. This intensive chemotherapy eliminates myeloma cells, but also destroys healthy blood-forming cells in the bone marrow. After chemotherapy, the patient’s collected stem cells are reinfused into their bloodstream. These reinfused cells travel to the bone marrow, where they engraft and restore the body’s ability to produce new, healthy blood cells, aiding recovery.
When Stem Cell Transplant is Recommended
A stem cell transplant is frequently considered for multiple myeloma patients under specific circumstances to achieve deeper and longer-lasting remissions. It is often recommended for newly diagnosed patients who meet certain criteria, particularly those with standard or high-risk disease features. The goal of this treatment is to improve progression-free survival, meaning the time a patient lives without the disease worsening.
Patient eligibility is a primary consideration, with age typically under 70 to 75 years old. Beyond age, a patient’s overall fitness and the absence of significant co-existing medical conditions, such as severe heart, lung, or kidney disease, are carefully evaluated. These factors determine a patient’s ability to tolerate the intensive nature of the transplant procedure.
While most commonly used in newly diagnosed, eligible patients, a stem cell transplant can also be considered in select cases of relapsed multiple myeloma. In these situations, the transplant may be used to re-establish disease control or to consolidate a response to salvage therapy. The decision depends on the patient’s prior treatments and their current health status.
Other Treatments for Multiple Myeloma
Beyond stem cell transplantation, many other treatment modalities are available for multiple myeloma. Immunomodulatory drugs (IMiDs), such as lenalidomide and pomalidomide, work by modulating the immune system and directly affecting myeloma cells. Proteasome inhibitors, including bortezomib and carfilzomib, block the action of proteasomes, leading to cancer cell death.
Monoclonal antibodies, like daratumumab and isatuximab, target specific proteins on myeloma cells for immune destruction. Conventional chemotherapy agents are also used, though their role has evolved with newer, more targeted therapies. Corticosteroids, such as dexamethasone, are frequently incorporated for their anti-myeloma effects and to manage side effects.
Radiation therapy is another option, typically reserved for localized purposes, such as alleviating bone pain or treating isolated myeloma areas. These various drug classes and treatment approaches offer flexibility in designing a tailored treatment plan.
Personalizing Multiple Myeloma Treatment
Multiple myeloma management is highly individualized. The healthcare team considers numerous factors when developing a treatment plan, including a patient’s age and overall health status, as co-existing medical conditions influence treatment tolerance and outcomes.
The specific characteristics of the myeloma, such as genetic mutations or disease aggressiveness, also play a significant role. A patient’s prior treatments and how they responded to those therapies inform subsequent decisions. Patient preferences and quality of life considerations are integral to the shared decision-making process.
Clinicians also weigh potential side effects and risks, aiming to maximize effectiveness while minimizing adverse impacts. Access to clinical trials offering novel therapies can also influence the treatment pathway. This comprehensive assessment ensures the chosen approach aligns with the patient’s unique profile and disease presentation.