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Chemotherapy and Stem Cell Transplantation

Autologous Stem Cell Transplantation

Autologous stem cell transplantation can be an important and effective therapy for myeloma patients. The chemotherapy used to treat myeloma damages your normal stem cells. Your doctor may recommend high-dose chemotherapy (called conditioning therapy) followed by a stem cell transplantation.

The drugs used before stem cell transplantation are different than those used for chemotherapy with no transplantation. You'll be given drugs that don't cause marrow damage. Common drug combinations include:

  • thalidomide (Thalomid®) and dexamethasone (Decadron®)
  • bortezomib (Velcade®) and Decadron
  • Velcade, pegylated liposomal doxorubicin (Doxil®) and Decadron

There are several kinds of stem cell transplantation. Myeloma is usually treated with autologous stem cell transplantation when your own noncancerous stem cells are "harvested," or retrieved, from your body and frozen. Your cells are returned to your body by injection after you receive intensive drug therapy.

The goal of an autologous stem cell transplant is to restore your body's ability to make normal blood cells after high-dose chemotherapy, but it's not a cure for myeloma. However, patients tend to respond well to autologous transplant.

Maintenance Therapy

You may need ongoing maintenance therapy after stem cell transplantation. There's currently no standard maintenance therapy at present; research on the outcomes of various approaches is underway. Results so far have been promising: Two recent large randomized studies that compared post transplant maintenance with low-dose Revlimid to placebo showed longer duration of response 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 Velcade and thalidomide, Velcade and Revlimid, or Velcade alone.

Allogeneic Stem Cell Transplantation

Allogeneic stem cell transplantation involves transferring stem cells from a healthy person (the donor) to the patient after high-intensity chemotherapy. An allogeneic stem cell transplantation is a high-risk procedure and not a common treatment for myeloma. It may sometimes be used for select younger patients who have a matched related or unrelated donor.

Researchers are trying to make allogeneic transplantation safer by using reduced-intensity allogeneic stem cell transplantation, also called nonmyeloablative transplant. Reduced-intensity allogeneic stem cell transplantation is sometimes used after autologous transplantation for patients who have a matched related or unrelated donor.

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last updated on Wednesday, April 24, 2013
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