Introduction

For newly diagnosed patients with symptomatic myeloma who have an adequate performance status, high-dose therapy and stem cell transplantation (HDT-SCT) remains the standard of care for younger and/or fitter myeloma patients.

This treatment option is limited to younger and/or fitter patients primarily because the possible benefits are almost certainly outweighed by the potential risks to older and/or less fit patients.

Often referred to as intensive treatment, HDT-SCT was developed in part because conventional standard dose chemotherapy failed to provide a deep and durable response in a large number of patients. It involves firstly giving standard dose induction treatment to remove the bulk of the myeloma followed by the administration of much higher doses of chemotherapy (melphalan) to remove the residual myeloma.

The HDT also destroys the healthy cells within the bone marrow. Therefore, replacement with healthy haematopoietic stem cells from the transplant is required to restore normal bone marrow function. Without a transplant, the effects of HDT are severely toxic and often life-threatening for patients.

HDT-SCT is considered to provide the best chance of achieving a deep and durable response and enhancing overall survival. However, as the procedure is associated with substantial side-effects, potential candidates for HDT-SCT must be in good physical condition with adequate kidney, lung and heart function.

Not all eligible patients wish to undergo HDT-SCT, preferring instead to undergo non-intensive treatment. In these situations, nurses should support such decisions and advocate on their patients’ behalf.

There are two types of SCT:

• Autologous (autograft) – using patients’ own stem cells
• Allogeneic (allograft) – using matched stem cells from a donor

This module focuses primarily on autologous SCT, the most common type of transplant performed in myeloma.