Autologous Stem Cell Transplant for Multiple Myeloma

Autologous Stem Cell Transplant (ASCT) is a transplant procedure in which your healthy blood stem cells are infused into your body after you have undergone high-dose chemotherapy. Cancers such as multiple myeloma & relapsed lymphoma affect the bone marrow cells. In an autologous transplant, your healthy cells are collected, stored, and transferred later on. ASCT is also used for cancers and disorders such as plasma cell disorders (multiple myeloma), Hodgkin's and Non-Hodgkin's lymphoma, neuroblastoma, relapsed AML (M3). ASCT is preferred usually below 65 years of age.

Alternate Name

Autologous bone marrow transplant

Body Location

Bone marrow

How Performed

ASCT is a closely monitored procedure that is carried out either under local anesthesia. The procedure involves the following steps:

• Pre Procedure: The disease should be in remission (Controlled)
• Stem cell mobilization: You will be given inj. filgrastim to increase the production of the stem cells and to promote their movement from bone marrow to the bloodstream.
• Collection: The stem cells are collected from bone marrow using apheresis machine
• Stem cell processing (apheresis): The blood is circulated through a machine that removes the stem cells from the blood and the blood is returned to your body.
• Conditioning: You will undergo treatment with high dose chemotherapy to kill the cancerous cells and these treatments also kill the stem cells from the blood.
• Return of stem cells: The stored stem cells will be infused into your bloodstream and they will start producing new blood cells once they reach the bone marrow.

Preparation

Before undergoing an autologous stem cell transplant, you will be screened by your oncologist or doctor to ascertain that you are healthy for this procedure and the disease is in remission (controlled) . The doctor will assess you on various parameters such as:

• Your performance status to evaluate your lifestyle, daily activities, and overall health status.
• Your age is a crucial factor to consider while planning ASCT as the elderly might not be able to tolerate the side effects of the high-dose therapy.
• Assessment of comorbidities such as obesity, diabetes, cardiovascular disease, depression, etc. might deem you unfit for transplant.
• Evaluation of organ functions such as renal, cardiac, pulmonary, and viral markers. Hence, you will be required to undergo kidney function tests, Echocardiogram, a pulmonary function test, and blood tests for viral labs such as HIV, hepatitis B, hepatitis C, cytomegalovirus, etc.

You should inform your doctor about all the medications you are taking especially blood thinners. You should stop smoking and consuming alcohol well before the procedure.

Instructions will be given to you on the type of foods to avoid before the transplant. You should be admitted 1 day prior to the procedure. HD Catheter is inserted for collection of stem cells in apheresis. You will be kept under observation for some time before the procedure.

Procedure Type

Invasive with injections/infusions to collect and replace the stem cells

Follow-up

Following the ASCT procedure, you will be kept in the hospital under active care for around 3 weeks until the process of new blood cell formation starts in your bone marrow. During this duration of 3 weeks, you will be given transfusions of red blood cells (RBC), platelets, etc. You will also be given antibiotics to prevent the onset of any potential infections as your immunity is at its lowest during these 3 weeks post-transplant. The medical staff around you will be wearing gloves, and masks, and will use sanitizers to keep the surroundings infection-free.

You will be required to visit your doctor every week for a follow-up to assess your overall health status and your response to the treatment. You will also be undergoing blood tests to evaluate the formation of the blood cells at least every two weeks. You might be advised to take nursing home care in case your condition remains critical at least during the initial weeks. On day 100, you will be thoroughly evaluated to assess the response and disease status. For that, you will undergo imaging procedures, bone marrow biopsy, and blood tests. Based on the assessment, you might be put on maintenance therapy at your doctor’s discretion.

Risks

ASCT is associated with various risks and side effects. The common side effects include the following:

• Hair loss (alopecia due to high dose of chemotherapy or radiation therapy)
• Nausea or vomiting
• Frequent infections such as common cold or related symptoms
• Diarrhea
• Chills
• Bleeding episodes
• Shortness of breath
• Skin rashes
• Fever
• Injection site swelling/redness/pain
• Weight loss
• Loss of appetite
• Anemia- deficiency of red blood cells
• Neutropenia- deficiency of the white blood cells making you prone to infections
• Joint pain and swelling
• Bone pain
• Loss of taste
• Sleeping disorder
• Mouth dryness and mouth sores
• Fatigue and loss of energy
• Neuropathy (nerve damage)

Recovery

The recovery process in the ASCT can take up to a few months and you must take extra precautions to stay away from infections while your immunity is rebuilding. After being discharged, avoid heavy work and seek help from family and friends. If required, you should opt for nursing care for the initial months to help you with daily chores. You should avoid going to swimming pools during the initial months after the transplant. Drink plenty of fluids and eat nutritious food to aid in quick recovery. Avoid public places, public toilets, and large crowded areas as these are potential sources of infection. You should not indulge in activities such as gardening, or playing with pets and poultry for at least 1 year after the transplant.

Regular follow-ups are critical to a healthy recovery as your doctor will monitor your progress. Take your prescribed medications as per the schedule and avoid any over-the-counter products. Always look for signs of complication and seek immediate medical attention, if required.