High-dose chemotherapy and autologous stem cell transplantation are important therapies for many myeloma patients.
Autologous Stem Cell Transplantation
During this procedure stem cells are collected from the patient, the patient is then treated with high doses of chemotherapy, often using melphalan. The cells are then returned to the patient via an infusion into the bloodstream (like a blood transfusion) to rescue the bone marrow from the effects of the high doses of chemotherapy. This procedure is associated with good response rates. It is relatively safe for many patients, including older patients, as a result of improved transplantation techniques and supportive therapies. However, it is not appropriate for all patients, and it is not a cure for myeloma. Patients should discuss the benefits and risks of any procedure with their doctors. Response to the transplant is measured by the standard tests used to monitor myeloma treatment, such as blood and urine protein levels, marrow tests and imaging studies. Myeloma patients who have had an autologous transplant may require maintenance therapy (see below).
Allogeneic Stem Cell Transplantation and Reduced-Intensity Allogeneic Stem Cell Transplantation
Allogeneic and reduced-intensity allogeneic transplantation are other types of stem cell transplants used to treat certain blood cancers; they are associated with higher rates of side effects and mortality than are likely with an autologous transplant. The main difference between autologous and allogeneic transplant is that in allogeneic transplant, the cells are obtained from a donor whose cells are compatible with those of the patient, usually a brother or sister. Selected patients may have an autologous transplant followed by an allogeneic transplant or a reduced-intensity allogeneic transplant.
Talk to your doctor to find out if a stem cell transplant is a treatment option for you.
Two recent large randomized studies that compared post-transplant maintenance with low-dose Revlimid® to placebo showed longer time before progression of myeloma for the patients who received Revlimid. Therefore, the use of Revlimid as post-transplant maintenance is emerging as the standard of care. More information is needed about the effects on overall survival as well as the risk of second cancers. There are several ongoing maintenance therapy trials evaluating the effectiveness of treatment with Revlimid, Velcade®, and combinations based on these and other approved drugs, as well as newer drugs.
For information about the drugs listed on this page, visit Drug Listings.