Clinical trial results suggest that frontline therapy that includes an immunomodulatory drug and a proteasome inhibitor in combination may result in response rates and duration of response comparable to those of stem cell transplant, allowing some patients to postpone transplant until later in the course of the disease. There is no conclusive clinical data to suggest that transplantation earlier in the treatment regimen is better than waiting until later. Therefore, general statements regarding patient outcomes both during the transplant procedure and post-transplant are inappropriate. While there are similarities between patients, each patient’s disease has its own distinct characteristics. These risk-related factors include the type and the stage of the disease, its aggressiveness and responsiveness to treatment, the levels of serum albumin and beta-2 microglobulin, and the presence or absence of certain chromosomal abnormalities in the patient’s myeloma cells. Transplant eligibility is evaluated on an individual basis. Some older patients are in excellent physical health and can be considered fit and transplant-eligible. Since high-dose chemotherapy is an intensive regimen, the patient must be medically fit enough to withstand it, with no major underlying medical issues. Transplant is usually recommended for patients under age 65. Patient-Related FactorsĪge is the first factor to consider. High-dose therapy with stem cell rescue is a treatment option for many multiple myeloma patients, but several factors must be taken into consideration. Are You a Stem Cell Transplant Candidate? "Allogeneic" transplant, in which donor stem cells are used instead of the patient's own cells, is not performed in myeloma outside the context of a clinical trial.
"Autologous" refers to the blood-making stem cells that are harvested from the patient to be a source of new blood cells after high-dose chemotherapy with melphalan. Autologous stem cell transplant can provide significant remission that is both long and deep, extending survival. The standard of care for fit multiple myeloma patients is to receive high-dose chemotherapy (HDT) with autologous stem cell rescue - otherwise known as autologous stem cell transplant (ASCT) - after completion of induction therapy. What Is Autologous Stem Cell Transplant (or Bone Marrow Transplant)?