Can A Stem Cell Transplant Cure Multiple Myeloma?
There is no cure for multiple myeloma (MM) the cancer can be controlled to some level with treatment. A stem cell transplant, it is one of the treatment methods of multiple myeloma and most patients go to a remission stage after stem cell transplant but cancer recurs after some time. It is not a cure but most patients remain in remission for years after stem cell transplant.
Hematopoietic stem cells are produced by the bone marrow, to retrieve cells for transplant stem cell growth factors are injected to the patient or the donor, then the bone marrow releases the stem cells to the bloodstream. These cells are harvested from the blood and stored appropriately to use in the future.
There are main 2 types of stem cell transplants
In autologous transplant, patient’s own stem cells either from the bone marrow or peripheral blood (now mostly harvested from peripheral blood) is removed or stored.
Then, the patient undergoes chemotherapy with or without radiotherapy to destroy the myeloma cells (healthy bone marrow cells are also destroyed in this process). Then the stem cells are transferred back to the patient’s blood in order to produce new hematopoietic cells. This is a standard treatment for multiple myeloma patients and most of the time the myeloma goes away but it comes back after a few years.
Tandem Transplant– This is having 2 autologous transplants in 6-12 months apart with medication/chemotherapy in between the transplants. This method may be effective than having just one transplant but the side effects are quite high.
In allogeneic transplants, stem cells are taken from a donor. The success of the transplant is more if the donor is a relative such as a brother or a sister of the patient, then the stem cells have more similarities. These transplanted cells can fight the remaining myeloma cells and destroy them. However, this transplant is not considered now as many patients had a poor short-term outcome.(1)
The Success Rate Of Stem Cell Transplant
Studies have shown that chemotherapy with autologous transplant has shown a better response to treatment and the 5-year even free period was also increased when compared with conventional therapies.
Studies done on single autologous transplant and tandem transplant shows that tandem transplant success rate is superior, these patients have near-complete response rate, fewer relapses, and increased event-free survival. Studies have found out that the long-term outcome from tandem transplant is more compared to the usual autologous transplant and this outcome is much more if the patient is given a high dose of chemotherapy. However, there is no real difference in the survival rate in both transplant methods. The chemotherapy dose and a number of transplants should be decided according to the individual patient and this decision will be taken by the team involved with the patient’s treatment.
Allogenic transplants are not done much because the transplant-related mortality is high and most patients develop complications such as graft-versus-host disease (the donor immune cells attack the patient’s body identifying those as foreign cells). It is shown that the death rate after 100 days of allogeneic transplant range from 10-56%.
Another retrospective case study shows that the median survival rate after autologous transplant is about 34 months whereas after allogeneic transplant it is about 18 months.(2)
Stem cell transplant is not a cure for multiple myeloma; it is another treatment modality for multiple myeloma patients so that they go into a cancer remission stage for a certain period, but cancer recurs after some time. There are two main types of stem cell transplants: autologous and allogeneic transplant. Autologous transplant is used mostly as the complications are less and the survival rates are high when compared to allogeneic transplant. Tandem transplant is a variation of autologous transplant where the patient undergoes two autologous transplants within 6-12 months and in between chemotherapy/radiotherapy is given to destroy the myeloma cells. Studies have shown that the response rate, relapse-free survival, and event-free survival rates are high with tandem transplant.
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