Intensive treatment for myeloma

Some patients with multiple myeloma may be treated with high dose chemotherapy or radiotherapy. These intensive treatments are given to improve the chance of complete remission. There have been good results in some trials, with patients having long periods of remission. There is no evidence at the moment that this treatment is a cure, but research is ongoing.

This is very intensive treatment, and your specialist will only offer it if you are fit enough to get through it. Generally, doctors are prepared to carry out high dose chemotherapy on people up to the age of 70. But this is only a guide. It is your fitness and general health that count, not your age in years. The main reason for having this treatment is that it is likely to give you the longest period of good health, with your disease in complete remission. Your specialist may also suggest it because your myeloma is causing troublesome symptoms. If you have already had chemotherapy and your myeloma has not responded, your specialist may not recommend high dose treatment because it is unlikely to help you.

The intensive treatment will kill off all your healthy bone marrow cells. The bone marrow is the spongy substance inside your bones. It contains the cells from which all your blood cells are made. These are called stem cells. If they are taken from the blood circulation they are called peripheral blood stem cells (PBSC). They have to be replaced so that you will survive the treatment. To replace them, you can either have a transfusion of

• Your own bone marrow (autologous bone marrow transplant)
• Stem cells from your own blood (peripheral blood stem cell rescue or autologous stem cell transplant)
• Someone else’s bone marrow or stem cells (allogeneic transplant)

Transplants using your own marrow or stem cells (autologous transplants) are used most often. Transplants with donor marrow or cells (allogeneic transplants) are not as commonly done.

You have the bone marrow or stem cells through a drip, into a vein. The cells find their own way to the centre of your bones and begin to make blood cells after a few days or weeks. So this is not a transplant as you may understand it. The only surgery involved is to remove the marrow, if you are having a bone marrow ‘transplant’.

If you are having a 'transplant' with your own stem cells, you must first have an injection of a small amount of chemotherapy and injections of growth factors for up to 10 days. The growth factor injections encourage your bone marrow to make lots of stem cells. The chemotherapy makes the stem cells spill out into your blood. Next, you will have the stem cells collected. To do this, you are connected up to a machine called a cell separator via 2 tubes that are like drip (intravenous infusion) tubes. Your blood goes out of one tube and into the machine. The machine takes out the stem cells and the rest is returned to you through the other tube. The stem cells are then frozen, ready to be given back to you after your high dose chemotherapy.

This is sometimes called a bone marrow harvest. It means having a minor operation under general anaesthetic. The marrow is sucked out with a large syringe from your hips and sometimes your breast bone. This is not as bad as it sounds! Usually you will only feel a bit bruised and need paracetamol for a couple of days.

Allogenic transplant means that the bone marrow or stem cells used for the transplant are from a donor, whose blood cells closely match your own. The most suitable donor is usually a close relative such as a brother or sister. In certain circumstances, it may be possible to get a match from an unrelated donor. This is known as a matched unrelated donor (MUD). To ensure that the donor’s bone marrow matches your own, special blood tests will be carried out. This is called tissue typing.

There is more information about bone marrow and stem cell transplants in the cancer treatment section of CancerHelp UK.