Through clinical trials, hematology-oncologist Hani Hassoun is working to improve stem cell transplantation for people newly diagnosed with multiple myeloma.
Stem cell transplantation, also called bone marrow transplantation, can be an effective part of treatment for multiple myeloma. In this procedure, hematopoietic or blood-forming stem cells — which reside in the bone marrow and can produce all types of blood cells, including white blood cells, red blood cells, and platelets — are collected from the patient or another person.
The patient then receives high-dose chemotherapy to destroy all the myeloma cells in the blood and bone marrow. Because the chemotherapy also destroys the bone marrow, a stem cell transplant with the previously collected cells is the next step in the treatment to replenish the bone marrow.
Types of Transplantation
There are two main types of stem cell transplantation: autologous transplantation, in which the patient’s own stem cells are collected before chemotherapy and then transplanted back into him or her, and allogeneic transplantation, in which the stem cells are obtained from a donor, most commonly a brother or sister.
For both autologous and allogeneic transplantations patients first receive high-dose chemotherapy to eradicate the cancer cells. Two days later, stem cells are infused into the bloodstream through an intravenous catheter in a procedure similar to a blood transfusion. Over the following days, the transplanted stem cells travel to the bone marrow, where they grow and develop into new mature blood cells, including red blood cells, white blood cells, and platelets.
It usually takes several weeks before all the mature blood cells are replenished. During this time, special measures are taken to protect a patient from infections and bleeding. Those undergoing stem cell transplantation are hospitalized for about three weeks; recovery takes several months.
Successful autologous and allogeneic transplants provide the patient with new, healthy bone marrow. Allogeneic transplants also give the patient a new immune system, which is derived from the donor’s stem cells and may help protect against cancer.
Stem Cell Transplantation Results
High-dose chemotherapy combined with stem cell transplantation is a standard therapy for patients with symptomatic (active) myeloma and has been shown to extend survival. (1) In some patients with myeloma, two consecutive transplantations two to four months apart — first autologous transplantation then allogeneic transplantation — have been shown to work better at controlling the disease than autologous transplantation alone. (2)
At Memorial Sloan Kettering, we are committed to improving the outcomes of patients who undergo stem cell transplantation for the treatment of multiple myeloma. Most patients who receive a stem cell transplant at our hospital recover extremely well.
In fact, an independent study conducted by the US National Marrow Donor Program in 2012 showed that Memorial Sloan Kettering significantly exceeded its predicted rate of one-year survival for patients undergoing allogeneic bone marrow transplantation.
In addition, we have developed new growth factors and other medications to increase the number of stem cells that are available for collection, which increases chances of a successful outcome after a transplant.
Memorial Sloan Kettering researchers are pursuing ways to improve the safety and effectiveness of stem cell transplantation. For example, a phase II trial is studying the effect of giving allogeneic stem cell transplants in four successive infusions on alternating days — rather than a single bulk infusion on one day — to determine whether the bone marrow recovers faster.
We are also studying a similar approach in a trial of autologous stem cell transplants, in which the patient’s own stem cells are returned in smaller amounts over several days rather than a single bulk infusion. Some studies have suggested that this approach helps increase bone marrow activity and decreases the time it takes for blood counts to recover after transplant. The hope is that this new technique may lower a patient’s risk of side effects and infections, decrease the number of blood transfusions that a patient needs during this process, reduce the time a patient has to spend in the hospital, and lower overall treatment costs.
Finally, our researchers are investigating whether stem cell transplantation is still necessary early in the course of treatment for multiple myeloma, given the effectiveness of new drugs such as lenalidomide and bortezomib.