Multiple myeloma starts in the bone marrow, the factory within the bones where all blood cells are created, and specifically forms in plasma cells. These plasma cells are part of the immune system responsible for helping to fight off infections. In multiple myeloma, normal plasma cells go through a series of changes, eventually causing excess cell growth that crowds the bone marrow, preventing production of healthy blood cells. Multiple myeloma can also cause other health problems as these abnormal plasma cells impact the other organs and systems throughout the body. These problems include having too much calcium in the blood, low blood cell counts, kidney damage, and frequent infections.
One form of treatment for myeloma is a stem cell transplant. Most myeloma patients who receive transplants undergo a procedure known as autologous stem cell transplant. Autologous stem cell transplant is also a common treatment option for other blood-related cancers, such as lymphoma. Multiple myeloma patients typically eligible for transplant include those with adequate organ function and those who are relatively fit and able to undergo high-dose chemotherapy which is often part of the pre-transplant conditioning regimen.
In autologous stem cell transplant, stem cells are obtained from the patient by a process called a stem cell harvest or stem cell apheresis. These cells are then usually frozen down in a processed referred to as cryopreservation. The cells are then thawed and infused back into the bloodstream after completion of intensive chemotherapy, allowing for recovery from the effects of this high-dose chemotherapy.
A second type of stem cell transplant, known as allogeneic stem cell transplant, is not as commonly used in myeloma patients as there can be more complications due to the use of stem cells from a related or unrelated donor. Ongoing clinical research has allowed physicians to perform allogeneic stem cell transplants in certain patients.
The Role of Autologous Stem Cell Transplant
Autologous stem cell transplant has a role in multiple myeloma treatment, however the timing and value of this form of treatment is an ongoing clinical research question with the advent of new classes of drugs to treat multiple myeloma, such as proteasome inhibitors, immunomodulating agents (IMiDs), deacetylase inhibitors and monoclonal antibodies. The development of these classes of drugs are beneficial as patients develop treatment resistance, and can be used in combination with other drugs to offer more clinically positive results for patients.
The impact of autologous stem cell transplant on overall survival is becoming clearer. Some studies have demonstrated impressive gains in progression free survival (the amount of time patients can live with the disease without it getting worse) and overall survival (the length of time from the start of treatment a patient is still alive) while undergoing maintenance therapy.
Preparing for and undergoing a transplant can be a long process. Physicians at the Weill Cornell Medicine and NewYork-Presbyterian Multiple Myeloma Center facilitate and conduct stem cell transplants for our patients since we are the most familiar with each individual’s specific needs. We offer an outpatient transplant program that is an option for patients. This is located at Helmsley Medical Tower, which is right next to the hospital. Throughout the transplant process, the team closely collaborates with Weill Cornell Medicine and NewYork-Presbyterian’s Bone Marrow and Stem Cell Transplant (BMT) Program to ensure the best possible care for each patient.
Myeloma Treatment at Weill Cornell Medicine and NewYork-Presbyterian
We treat each patient as an individual and narrowly-tailor our treatment plans to meet our patients’ needs. Our physicians take many factors into consideration when making treatment decisions, including:
- How a patient prefers to receive therapy (For example: oral medications versus receiving infusions).
- The patient’s work schedule. For example, if a patient works full-time five days per week, he or she may not have the time to come to the clinic for weekly infusions.
- Whether someone has any other health conditions that may impact the ability to undergo a transplant procedure.
- The cost of treatment. Depending on each person’s health insurance, certain treatments may be more expensive than others, requiring out-of-pocket costs.
For transplant-eligible patients, our approach often integrates the combination of high-dose chemotherapy and autologous stem cell transplantation. Research has demonstrated that this approach produces superior response rates and progression free survival.