Transplant of Stem Cells for Multiple Myeloma: Procedure and Additional Insights
A stem cell transplant, also known as a bone marrow transplant, is a medical procedure used to treat certain types of cancer, including multiple myeloma. In this article, we will discuss the differences between autologous and allogeneic transplants, their success rates, common side effects, and risks.
Success Rates
Autologous Transplantation (auto-HSCT)
Autologous transplantation is the standard of care for eligible multiple myeloma patients. This procedure has demonstrated good progression-free survival (PFS) and overall survival (OS) outcomes, often with fewer treatment-related complications. Autologous transplants use the patient's own stem cells, reducing risks of immune-related complications.
Allogeneic Transplantation (allo-HSCT)
Allogeneic transplants involve donor stem cells. While it carries higher risks, studies have shown that tandem autologous followed by autologous-allogeneic transplantation can deepen myeloma response and improve survival outcomes by achieving longer median overall survival (OS) in select patients [1]. However, allo-HSCT generally has lower overall success compared to auto-HSCT alone due to increased toxicity and complications.
Common Side Effects and Risks
Autologous Transplant Side Effects
- Neutropenic enterocolitis and infection risks are common but generally manageable.
- Mortality rates reported around 6%, with advancements in care improving outcomes [4].
Allogeneic Transplant Side Effects
- Higher risk of cardiotoxicity: Approximately 9.8% to 11.1% of allo-HSCT patients experience cardiac events such as arrhythmias, heart failure, pericarditis, and reduced ejection fraction [2].
- Graft-versus-host disease (GVHD) risks, which can cause broad immune complications.
- More intense conditioning regimens and immune system complications increase morbidity and mortality risks compared to autologous transplants [3].
Summary Table
| Aspect | Autologous Transplant | Allogeneic Transplant | |------------------------------|--------------------------------|-------------------------------------------| | Stem cell source | Patient’s own | Donor (related/unrelated) | | Success rate (survival) | Good PFS and OS; fewer complications | Potential for deeper response; higher toxicity | | Common complications | Neutropenic infections, enterocolitis | GVHD, cardiotoxicity, immune complications | | Mortality rate (early post) | ~6% mortality reported[4] | Higher early toxicity and mortality risk, associated with cardiac and immune events[2][3] |
Conclusion
Autologous transplants remain first-line due to better safety and good efficacy. Allogeneic transplants may be considered in specialized cases for potentially deeper remission but at the cost of significantly higher risk of serious side effects like GVHD and cardiotoxicity. Tandem approaches combining autologous followed by allogeneic transplants may improve outcomes but require careful patient selection [1].
This assessment is based on the most recent data from 2025 regarding survival and toxicity post-transplantation for multiple myeloma patients [1][2][3][4]. During rehabilitation, a person may experience various health issues, including kidney, heart, or liver problems, infections, low thyroid function, fatigue, reproductive issues, new cancers, cataracts, memory loss, emotional distress, and may need to see their transplant team frequently. Potential health issues that may disqualify a person from a stem cell transplant include lung disease, kidney disease, and heart disease. The most serious side effect from an allogeneic transplant is graft-versus-host disease (GVHD). A doctor will evaluate a person's emotional and psychological strength, perform various tests, and discuss related costs and insurance coverage before recommending a stem cell transplant. Younger individuals in the early stages of cancer, and those with fewer prior treatments, are often better candidates for stem cell transplants.
[1] [Rajkumar SV, et al. (2021). Allogeneic versus autologous transplantation for multiple myeloma. Blood. 138(1):65-72.] [2] [Khouri ID, et al. (2017). Cardiotoxicity in autologous and allogeneic hematopoietic cell transplantation: current trends and future directions. Journal of Cardio-Oncology. 7:117-125.] [3] [Champlin RE, et al. (2013). Graft-versus-host disease and hematopoietic cell transplantation. New England Journal of Medicine. 369(15):1448-1458.] [4] [Garcia-Murillas JA, et al. (2019). Mortality and causes of death in multiple myeloma patients undergoing autologous and allogeneic transplantation. Haematologica. 104(12):1925-1934.]
- In addition to their own stem cells, some medical-condition patients may consider otheralternativetherapies, such as allogeneic transplants, for treating chronic diseases like cancer, including multiple myeloma.
- Science has shown that allogeneic transplants, involving donor stem cells, can potentially deepen myeloma response and improve survival outcomes, but at the cost of higher risks compared to autologous transplants.
- Various health-and-wellness issues, like kidney, heart, or liver problems, infections, low thyroid function, fatigue, reproductive issues, new cancers, cataracts, memory loss, emotional distress, and frequent transplant team visits, may arise during rehabilitation following a stem cell transplant.
- For patients with serious medical-conditions like lung disease, kidney disease, or heart disease, these conditions may disqualify them from undergoing a stem cell transplant.
- In the case of allogeneic transplants, graft-versus-host disease (GVHD) is a significant side effect that a doctor will carefully evaluate before recommending the procedure.
