MM Stem cell transplant – What happens in a stem cell transplant?

Danielle Barron reports

Autologous stem cell transplantation (ASCT) is a common treatment for patients with multiple myeloma. It involves the removal or “harvesting” of stem cells from the patient’s blood. These are then stored (cryopreserved) while the patient receives high dose chemotherapy, after which the stem cells are returned to the patient. It remains the most effective treatment for inducing remission from multiple myeloma. But what exactly is involved in the whole process? Liz Higgins is a nurse and Stem Cell transplant coordinator at St James’s Hospital. She explains that their unit carries out around 60 stem cell transplants a year for multiple myeloma.

Who is eligible for a stem cell transplant?
St James’s runs weekly Transplant counselling clinics where all patients referred for consideration of a Stem Cell Transplant are assessed – firstly to ensure this is the correct treatment pathway for them and secondly to assess if they are fit enough to proceed with the treatment. – There are Toxicities associated with this procedure and the team want to ensure as much as is possible that it is the best treatment choice for each individual patient. – The decision in relation to fitness to proceed lies primarily with the transplant team, however this is in consultation with the patients referring team.

What impact can the transplant have on a patient’s prognosis?
This treatment is not curative but all the international evidence and reviews would still say stem cell transplant is the best treatment to prolong remission period. In some years’ time transplantation might be obsolete, but certainly right now it remains the treatment of choice for patients who are fit enough. Outcomes vary from patient to patient. The intent is to try to keep the patient in remission as long as possible.

Explain the patient’s journey through the stem cell transplant process.
Patients will first attend the transplant counselling clinic. We ask all patients who are attending to bring a significant other with them to this clinic; there is a lot of information given on the day and it is difficult to remember everything. The transplant coordinator will arrange a stem cell harvest, where the stem cells are removed from the blood via apheresis. The cells are then taken to the lab where they are frozen (cryopreserved) until required.

The patient then goes home for a period of time before they are readmitted for a three to four-week inpatient period. Most patients receive two days of high dose chemotherapy always administered in a specialist ward with specialist doctors and nurses. The stored stem cells will then be given back to the patient normally one to two days later; they are given by an intravenous infusion or drip.

There is then a period of four to five days where the patient will feel quite ill. They get a sore mouth and gut and therefore experience gastrointestinal difficulties such as nausea, diarrhoea and cramps. The gastrointestinal toxicity is a side effect of the high dose chemotherapy.

At this point the blood counts are extremely low, so infection may also be a problem; however all these effects are managed by the medical and nursing team, we endeavour to make the journey as easy as possible for the patient. Once the blood counts have recovered, and there are no infections and the patient is eating and drinking, they can go home. They will feel well on discharge but will be most likely very fatigued.

What do patients want to know?
What to bring –
Less is best, however they do need to bring pyjamas/ or comfortable clothing – to change daily, toiletries.
They can bring mobile phone, iPad etc, books.
Visitors –
Visitors should be restricted, but family can certainly visit. We ask that anybody with flu-like illness, or diarrhoea/ vomiting illness do NOT come to visit. This is extremely important in relation to infection control.