Stem Cell Transplantation with High-Dose Chemotherapy

High-dose chemotherapy and stem cell transplantation are important parts of treatment plans for eligible, recently diagnosed myeloma patients. One of the following types of transplants may be used:

  • Single or tandem (back-to-back) autologous stem cell transplant 
  • Standard or reduced intensity conditioning allogeneic stem cell transplant 

Autologous Stem Cell Transplantation for Myeloma

Autologous stem cell transplantation is associated with good response rates and remains the standard of care after completion of induction therapy, for eligible patients as determined by the transplant team. However, autologous transplant is not appropriate for all patients and is not a cure for myeloma.

How does an autologous stem cell transplantation work? 

The patient’s own stem cells are collected for this type of stem cell transplant. These collected cells are eventually transfused back into the patient's bloodstream. 

If needed, a doctor may use special medications to help "mobilize" stem cells to move more stem cells from the marrow and into the bloodstream so that more can be collected. 

The patient is then treated with high doses of chemotherapy, typically melphalan. 

After chemotherapy, the stem cells are returned to the patient's bloodstream by IV (similar to a blood transfusion). The goal is for the stem cells to restore normal blood cell production. 

Patients may need maintenance therapy after autologous stem cell transplantation. 

Tandem Autologous Stem Cell Transplantation

This term refers to a planned second course of high-dose chemotherapy and stem cell transplant within 6 months of the first course. According to recent studies, this should only be considered as a treatment option in patients who fail to achieve a good response with the first transplant, in select patients with high-risk cytogenetic features.

Allogeneic Stem Cell Transplantation

Due to the risks of allogeneic transplantation, it has a limited role in myeloma treatment, and it should only be done in the context of a clinical trial.

Allogeneic transplantation is mainly considered to be a therapeutic option for young patients with high-risk disease who have experienced a relapse and are willing to accept the risks associated with this type of transplant, in exchange for a better chance at long-term survival.

Maintenance Therapy for Myeloma 

This is the continued use of therapy to maintain the response obtained with induction therapy or stem cell transplantation. During maintenance therapy, medications are given at lower doses or with less frequency to keep the successful results of prior treatment going.

Lenalidomide (Revlimid®) is the preferred agent for post-transplant maintenance, based on the results of several clinical trials. It does not produce the neurotoxicity of other immunomodulatory drugs, such as thalidomide. However, lenalidomide appears to increase the risk for developing a secondary cancer during maintenance therapy, especially after transplantation or after therapy with a regimen that contains melphalan. 

Maintenance therapy with bortezomib (Velcade®) or ixazomib (Ninlaro®) is recommended for patients with certain cytogenetic abnormalities.

Maintenance therapy is intended to be continued over the long term. If, or when, there are signs and/or symptoms indicating disease progression, you and your doctor will discuss additional treatment. Patients should share their questions or concerns about disease progression and future treatments with their treatment team. Studies remain ongoing to determine the optimal maintenance regimen and duration of maintenance therapy.

For information about the drugs listed on this page, visit Drug Listings.

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