NCCN Guidelines for Patients™: Multiple Myeloma
3.3 Stem cell transplant
This treatment uses high doses of chemotherapy to
destroy bone marrow and then replace it with healthy
blood stem cells. The transplanted stem cells should
make new bone marrow. The steps of treatment with
stem cell transplant are described on the next pages.
Types of stem cell transplants
Autologous stem cell transplant
This type of transplant uses your own stem cells that
are collected after primary chemotherapy. Autologous
stem cell transplant is the most common type of
transplant used for active myeloma. However, it is not
considered a cure because the myeloma may come
back even after long periods of disease control.
Tandem stem cell transplant
This is a type of autologous transplant. A second round
of high-dose chemotherapy and a second autologous
stem cell transplant are given. These treatments are
done within 6 months after the first transplant.
Allogeneic stem cell transplant
This type of transplant uses stem cells collected from
another person, called a donor. Before the transplant,
HLA typing is needed to check if you and the donor are a
good match. See page 14 for more details on HLA typing.
This transplant may provide the best chance to cure
myeloma although chances are low. A cure may be
possible because you’ll have a new immune system
from the donor’s healthy stem cells. What’s more, this
transplant also causes the GVT (
effect. The GVT effect is when the transplanted stem
cells (the graft) attack the myeloma cells in your body
(the tumor) as invaders.
Allogeneic stem cell transplants aren’t used very often
for three reasons. First, it’s hard to find a matching donor.
Second, side effects are serious and include death. Third,
the risk of the myeloma coming back is still high.
This is a type of allogeneic transplant. It is called
a “mini” transplant because lower doses of
chemotherapy, radiation therapy, or both are given
before the transplant. The purpose of a mini transplant
is to reduce the severity of side effects, but still have
the GVT effect.
Donor lymphocyte infusion
A donor lymphocyte infusion is a transfer of
lymphocytes to you from the same donor of the stem
cells for the allogeneic transplant. Lymphocytes are
a type of white blood cell that helps the body fight
infections. The purpose of a donor lymphocyte infusion
is to stimulate the GVT effect. This treatment may
be used if the myeloma comes back after the first
allogeneic stem cell transplant.