32 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 3 Myeloma treatments Stem cell transplants Types of stem cell transplants Autologous stem cell transplant This transplant uses your own blood stem cells that are collected after primary treatment or high- dose therapy. The intent is to use high doses of chemotherapy to kill the maximum amount of myeloma cells and then help the bone marrow recover by putting the blood stem cells back into your bloodstream. From there, they travel to your bone marrow and grow. Autologous stem cell transplant is the most common type of transplant used for active (symptomatic) myeloma. But, it is not considered a cure because the myeloma may come back even after long periods of disease control. Tandem stem cell transplant A tandem transplant is when a planned second round of high-dose chemotherapy and a second stem cell transplant are given after the first autologous transplant. The second transplant can be autologous or allogeneic. It is typically done within 6 months after the first transplant. Allogeneic stem cell transplant This type of transplant uses blood stem cells 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 18 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 the donor’s healthy blood stem cells create a new immune system for your body. Another benefit of this transplant is the GVT ( g raft- v ersus -t umor) effect. The GVT effect is an attack on the myeloma cells by the transplanted donor blood stem cells. 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 can include death. Third, the risk of the myeloma coming back is still high. Donor lymphocyte infusion A donor lymphocyte infusion is a procedure in which the patient receives lymphocytes from the same person who donated blood stem cells for the original allogeneic transplant. A lymphocyte is 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. Mini transplant 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 goal of a mini transplant is to still have the GVT effect but with less severe side effects.