Am I a Candidate for a Transplant?
A stem cell transplant is a treatment option for many myeloma patients; however, it is not a cure. It can improve the duration of remission and survival. It can also provide a better quality of life for most patients. Not all patients with myeloma are candidates for a stem cell transplant. Many factors must be taken into consideration. These include factors related to the myeloma itself and patient-related factors.

Myeloma-Related Factors

• type of myeloma
• disease stage
• disease aggressiveness
• responsiveness to treatment
• serum albumin
• beta-2 microglobulin
• chromosome analysis

Patient-Related Factors

• age
• health status
• kidney, heart, lung, and liver function
• patient preference

We cannot stress enough that myeloma is a highly individualized disease. While there are similarities between patients, each patient’s disease has its own distinct characteristics. There will be testing to determine how much myeloma there is in your body and how aggressive it is. All of these variables will be weighed before determining whether a transplant is appropriate for you. Therefore, general statements regarding patient outcomes both during the transplant procedure and post transplant are inappropriate.

When to transplant is also an important consideration. Most transplant physicians believe it is better to perform the transplant early in the disease course. However, there is no absolute clinical data to suggest that transplantation earlier in the treatment regimen is better than waiting until later. Recent trial results suggest that frontline therapy that includes the anti-myeloma agents thalidomide, Revlimid®, and/or VELCADE® may result in response rates and duration of response comparable to those of stem cell transplant, allowing some patients to postpone transplant until later in the course of the disease. This is undergoing further investigation. 

Remember, in most cases, unlike a heart attack, myeloma gives the patient the luxury of time to do some homework and to gather the information needed to make an informed decision about what’s right for him or her. For example, one could have stem cells harvested and saved for a later treatment. This leaves the patient open to other more immediate treatment options. These are things to discuss with the doctor. It’s important to remember that even if someone is a good transplant candidate, the ultimate decision about whether or not to have a transplant is the patient’s.

What is a transplant?

Value of a transplant

How to decide if you need a transplant

The Transplant Procedure

Transplants and Clinical Trials

Psychosocial Issues

REFERENCES

©2011 International Myeloma Foundation