Multiple Myeloma Program

Autologous Stem Cell Transplant

What is an autologous stem cell transplant?

Autologous means "from the same individual." In an autologous stem cell transplant, the patient serves as his or her own donor. The patient's own healthy cells will be collected from the peripheral blood before giving high-dose chemotherapy, and then given back
after chemotherapy.

The purpose of the stem cell transplant is to be able to give high-dose chemotherapy safely, reducing the risks of complications. High-dose chemotherapy
is very effective at killing myeloma cells, but it also destroys some healthy cells in the process. For example, the production of new blood cells in the bone marrow will be hampered for some time after high-dose chemotherapy. As a consequence, after high-dose chemotherapy, patients go through a period where they are more likely to experience infections and/or bleedings. Giving patients back their own healthy stem cells after high-dose chemotherapy allows the bone marrow to rebuild blood and immune cells more quickly.

Most autologous transplants can be done safely on an outpatient basis with careful monitoring. However, if clinically indicated we will also be happy to admit the patient to our BMT floor for the autologous transplant.

What are the steps during an autologous stem cell transplant?

The first step is to collect the bone marrow stem cells. Today we use a method called mobilization during which the patient will receive injections of certain growth factors. This tricks the stem cells into leaving the bone marrow and going into the peripheral blood, where they can be collected more easily.

The stem cells are collected using an intravenous line, or central line, that is inserted into the chest. Blood is withdrawn and circulated through an apheresis machine, which is a device that separates white blood cells from the rest of the blood. The white blood cells contain the stem cells.

White blood cells make up less than 1% of our blood. When the white cells are collected, the rest of the blood (the other 99%) is returned to the patient through the machine. The stem cells are frozen until it is time to give them back to the patient.

Next, the patient receives high-dose chemotherapy to fight the myeloma. The chemotherapy contains of anti-cancer drugs like melphalan. The chemotherapy can potentially have certain side effects, so the patient may get other medications to fight the side effects.

The next step is to give back some of the healthy stem to the patient. Some of the cells are thawed and given back, or infused, through the central line in the chest. The rest of the stem cells will stay frozen and be stored for later use, if needed. After the stem cells are infused, they will travel from the blood stream back into the bone marrow.

The infused cells will now rebuild the blood and the immune system. The patient is monitored to see if engraftment occurs. Engraftment is when the body starts to reproduce white blood cells, red blood cells, and platelets and can once again fight infection. Engraftment usually occurs 12 to 15 days after the stem cells have been given back.

We ask patients to stay in the Salt Lake City area for about 4 weeks during their transplant. The transplant is usually done on an outpatient basis, and patients don't need to spend the night at the hospital. However, patients will need to return to the hospital frequently for monitoring.

Tandem Autologous Transplant

A tandem autologous transplant means that two autologous transplants are done within six months. This is also known as a double autologous transplant. For more than 90% of transplant-eligible patients one transplant is enough and an additional transplant will only lead to more side effects without an additional clinical benefit.

For more information, or to schedule an appointment, call 801-587-4652