Stem cell transplant is still the single most effective treatment for multiple myeloma, yet 45% of patients are never given this therapy, according to Dr. Sergio Giralt of the Memorial Sloan Kettering Cancer Center. While transplant is not a fun process for patients it can be done successfully, even for older patients, if we are fit enough to undergo the procedure.
In a short video, Dr. Rafael Fonseca of the Mayo Clinic in Scottsdale explains the reasons why patients should receive a stem cell transplant and demystifies the process in detail. He tells us that transplant is a key tool in the management of myeloma and should be used as an up-front procedure because it adds time of disease control and extends the time to relapse. On average, patients who receive stem cell transplant can go 5-6 years before needing an additional major interventional therapy. For a small subset of patients, it could be the last intensive treatment they need.
He outlines the steps to transplant for an in-patient stem cell transplant, though many centers also offer it as an out-patient procedure:
- Gather stem cells
- Physical exam
- Picc line installation
- Admission to hospital – chemo through IV – melphalan – anti-nausea medicine
- Ice chips – reduce blood flow to lining of mouth. Reduces mouth sores.
- Day after – rest day
- Stem cells given back – bagged and infused. Practitioners are dressed in gowns to prevent infection.
- How do cells get back to bone marrow? They have recpetors to know where to go.
- Two weeks before they fully recover.
- During that two weeks the old bone marrow dies and the new bone marrow grows.
- First week most patients do pretty well. Some GI issues can happen.
- Second week is harder with potential GI issues that will eventually resolve. Symptoms not uniform.
- Counts have recovered. Eating and drinking fine.
- Cells come back around day 12
- White count low – if you have a fever, treat with antibiotics then ask questions later. Can just be bacteria passing through your body.
- Low platelet count – can do a transfusion if needed. Low platelets aren’t a major issue but something they monitor.
- If you need red cell transfusion, it can be there too.
- Stay away from crowds but visitors are fine.
- After 2 months do assessment again.
We hope you enjoy this informative video by Dr. Fonseca about this key procedure in multiple myeloma.