29 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 3 Myeloma treatments Steroids | Stem cell transplant Most of the chemotherapy drugs listed in Guide 2 are liquids that are slowly injected into a vein. Some are a pill that is swallowed. The drugs travel in the bloodstream to treat cancer throughout the body. This is called systemic therapy. Side effects of chemotherapy Like targeted therapy, the side effects of chemotherapy depend on many factors. This includes the drug, the dose, and the person. In general, side effects are caused by the death of fast-growing cells, which are found in the intestines, mouth, and blood. Thus, common side effects of chemotherapy are nausea, vomiting, diarrhea, mouth sores, not feeling hungry, hair loss, and low blood cell counts. Feeling very tired (fatigue) or weak is also common. Not all side effects of chemotherapy are listed here. Be sure to ask your treatment team for a complete list of common and rare side effects. If a side effect bothers you, tell your treatment team. There may be ways to help you feel better. There are also ways to prevent some side effects. Steroids Steroids are a type of drug used to relieve swelling and inflammation, but some steroids have anti- cancer effects. Steroids are often used in the treatment of myeloma because of their anti-cancer effects. Steroids can be used alone to treat myeloma or used with chemotherapy, targeted therapy, or both. See Guide 2 on page 27. Side effects of steroids Most side effects of steroids go away over time once the drugs are stopped. Some common side effects are feeling hungry, trouble sleeping, slow wound healing, upset stomach, and swelling in the ankles, feet, and hands. Steroids also make some people feel irritable and cranky. Changes in mood can happen from day to day. When used for a long time steroids can lead to weakening of bones, thinning of skin, weight gain, and an increased risk of infections. Stem cell transplant Blood stem cells are cells that develop into all types of mature blood cells. Blood stem cells and mature blood cells are made in bone marrow. Cancer or its treatment can damage or destroy cells in the bone marrow. A stem cell transplant is a treatment that replaces the damaged or destroyed cells in the bone marrow with healthy blood stem cells. The goal of a stem cell transplant is to treat cancer by giving powerful chemotherapy and then replacing the stem cells to allow the bone marrow to recover. This is done by suppressing the bone marrow and cancer with chemotherapy then transplanting healthy blood stem cells. The healthy blood stem cells will grow and form new bone marrow and blood cells. There are two main types of stem cell transplants. An autologous stem cell transplant uses your own blood stem cells to regrow the bone marrow after the high-dose chemotherapy. An allogeneic stem cell transplant uses blood stem cells that come from another person (donor). See page 32 for more details about the types of stem cell transplants. The steps of treatment with a stem cell transplant are described next. Collecting the stem cells The first step of a stem cell transplant is to collect, or harvest, the blood stem cells. Blood stem cells are found in the bone marrow and in the bloodstream. For myeloma treatment, blood stem cells are usually taken from the blood.