NCCN Guidelines for Patients® | Multiple Myeloma - page 29

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NCCN Guidelines for Patients
®
Multiple Myeloma, Version 1.2014
3
Treatments for myeloma
Stem cell transplant
Stem cell transplant
A stem cell transplant is a medical procedure that
uses high doses of chemotherapy to destroy diseased
and normal cells in the bone marrow and then replace
them with healthy blood stem cells. The transplanted
stem cells should make new bone marrow. The steps
of treatment with a stem cell transplant are described
on the next pages.
Collecting the stem cells
The first step of a stem cell transplant is to collect,
or harvest, the stem cells. Stem cells are located
in the bone marrow as well as in the bloodstream.
Stem cells can be collected from you or from another
person, called a donor. Your doctor will likely collect
enough stem cells from you for two transplant
procedures.
For myeloma treatment, stem cells are usually
collected from circulating (peripheral) blood in the
bloodstream. With this method, the first step is to
remove blood from a large vein in the arm using a
central venous catheter. The blood is then filtered
through a machine that removes the stem cells and
returns the rest of the blood to you, or the donor,
through the catheter. This process is called apheresis.
Next, the harvested cells are combined with a
preservative, frozen, and stored to keep them alive
until they are transplanted into you. This process is
called cryopreservation. Apheresis typically takes 4
to 6 hours and does not require anesthesia. It usually
causes only mild discomfort such as lightheadedness,
chills, numbness around the lips, and cramping in the
hands during the procedure.
Stem cells can also be collected from your bone
marrow using bone marrow aspirations. In this
procedure, you will be given regional anesthesia or
general anesthesia. Next, a needle will be inserted
through your skin into your hip bone (or, rarely, the
breastbone) to draw out the bone marrow. The needle
must be inserted several times into one or more spots
in the bone to collect enough bone marrow. The bone
marrow will then be processed to collect the stem
cells. The stem cells will be cryopreserved until the
transplant. Collection of the bone marrow takes about
1 hour and will likely cause some pain and soreness
for a few days afterward. Other side effects, related to
the anesthesia, may include nausea, headache, and
tiredness.
High-dose chemotherapy
After the stem cells have been harvested, high doses
of chemotherapy are given to destroy any remaining
myeloma cells in the bone marrow. The high-dose
chemotherapy also destroys normal cells in the bone
marrow, including plasma cells and blood stem cells.
This greatly weakens your immune system so that
your body doesn’t kill the transplanted stem cells.
However, not every person can tolerate the high-dose
chemotherapy before the transplant.
Transplanting the stem cells
Once the high-dose chemotherapy is complete, the
harvested stem cells are put into your body with
a transfusion. A transfusion is when you receive
whole blood or parts of blood put directly into your
bloodstream through a vein. This process can take 1
to 5 hours to complete.
The transplanted stem cells then travel to your bone
marrow and grow to make new healthy blood cells.
This process is called engraftment and it usually
occurs about 2 to 4 weeks after the transplant. Until
then you have little or no immune defense and so you
are at high risk for infection and bleeding. Therefore,
you likely will need to stay in a hospital in a very
clean (sterile) unit for about 2 weeks. You may be
given antibiotic drugs to prevent or treat infection.
You may also be given blood transfusions to prevent
bleeding and to treat anemia. It may take a few weeks
or months for blood cells to fully recover so that your
immune system is back to normal.
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