30 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 3 Myeloma treatments Stem cell transplants Your doctor will likely collect enough blood stem cells for two transplant procedures in case they’re needed as an option for future treatment. If blood stem cells will be taken from the blood, then a process called apheresis will be done. First, medicine will be given to increase the number of blood stem cells in the blood. Then, some blood will be removed from a large vein most likely in your arm. The blood will flow through a tube and into a machine that removes the blood stem cells. The rest of the blood will be returned through a tube in the other arm. Apheresis typically takes 4 to 6 hours and does not require anesthesia. It may take a few sessions to obtain enough blood stem cells. This procedure may cause lightheadedness, chills, numbness around the lips, and cramping in the hands. If blood stem cells will be taken from bone marrow, then bone marrow aspirations will be used. For this procedure, general anesthesia will be given. Next, a needle will be inserted through the skin into the hip bone to draw out the bone marrow. The needle must be inserted many times into one or more spots in the bone to collect enough bone marrow. The bone marrow will then be processed to collect the blood stem cells. Collection of the bone marrow takes about 1 to 2 hours. You may be observed in the hospital overnight. The aspiration will likely cause some pain and soreness for a few days. Anesthesia may cause nausea, headache, and tiredness. Blood stem cells are very rarely collected from bone marrow in patients with myeloma. Most often, they are taken from the blood as described above. After apheresis or aspiration, the harvested blood stem cells will be combined with a preservative. Then, they will be frozen and stored to keep them alive until the transplant. This process is called cryopreservation. High-dose chemotherapy Before the transplant, you will receive high-dose chemotherapy. This is called conditioning treatment since it prepares (conditions) your body to receive the blood stem cells that were collected earlier. The chemotherapy is given to destroy any remaining myeloma cells in your bone marrow. But, it also destroys normal cells in your bone marrow. This greatly weakens your immune system so that your body doesn’t kill the transplanted blood stem cells when the cells are coming from a donor. However, not every person can tolerate the high- dose chemotherapy before the transplant. If a stem cell transplant is being considered, your doctor will do a lot of tests of your heart, lungs, kidneys, and general health before deciding if you can handle this kind of treatment. Transplanting the stem cells After the chemotherapy, the blood stem cells will be put into your body with a transfusion. A transfusion is a slow injection of blood products into a large vein. This process can take several hours to complete. The transplanted stem cells will then travel to your bone marrow and grow. They will make new, healthy blood cells. This is called engraftment. It usually takes about 2 to 4 weeks. Until then you will have little or no immune defense. This puts you at high risk for infection and bleeding. You may need to stay in a hospital in a very clean room for some time. It may take a few weeks or months for blood cells to fully recover so that your immune system is back to normal. Side effects of stem cell transplant A side effect is an unhealthy or unpleasant physical or emotional condition caused by treatment. Common side effects of chemotherapy, which is given before the transplant, are described on page 29.