Not everyone is eligible for a stem cell transplant.

Your doctor will assess your eligibility based on the following criteria:

• < 65 years: good candidate.
• 65 - 75 years: eligible depending on your overall health and extent of cancer.
• >75 years: not eligible.

Performance status:

You are eligible if you are able to carry on normal activity, only have minor signs and symptoms of the disease.

Performance status:

Your doctor will use scoring systems to assess whether you are in a low risk/ high risk category for a stem cell transplant.

Some of the criteria include:

• Presence of abnormal chromosomal DNA changes.
• History of arrythmia or cardiac disease.
• Cerebrovascular disease (such as stroke).
• Diabetes and obesity.
• Inflammatory bowel disease or peptic ulcer.
• Infection or rheumatic disease.

Prior to stem cell transplant, you will have received induction therapy (usually standard triple therapy) for a few months at least.

Once assessed as eligible for a stem cell transplant you go through a 3 step-process.

Harvesting stem cells

• For myeloma treatment, blood stem cells are usually collected from the blood stream. This process can take up to 3 to 4 hours.
• A machine called apheresis machine separates the stem cells from the blood, returning the blood back into your body. The harvested stem cells are then frozen for future use.

Conditioning

• In this step, you will receive high-dose chemotherapy or radiation to kill all the cells including the myeloma cells residing in your bone marrow.
• This typically takes 1-2 weeks. Since the process also destroys the normal cells in your bone marrow, it greatly weakens your immune system increasing your chance for infections.

Transplanting the stem cells

• One or two days after chemotherapy, you are ready for the transplant.
• The harvested stem cells will be slowly introduced back into your body through a transfusion.
• Stem cell transplant can be an outpatient procedure and typically takes a few hours. You may still need to return to the hospital during the recovery period.

You may experience side effects at different stages of the stem cell transplant process.

Chemotherapy and radiation effects during conditioning

Fatigue

Nausea or vomiting

Diarrhea

Reduced appetite

Hair loss

Mouth ulcers

Stem cell infusion side effects

A strong garlicky taste or scent

Fever and chills

Shortness of breath

Hives

Reduced urination

Low blood pressure

If you have had an allogenic transplant, graft vs host’s disease is a serious side effect caused by the immune cells from the donor recognizing and attacking your own body as foreign.

Some long term side effects of stem cell transplant appear after a year or more and include frequent infections, extreme fatigue, low thyroid hormone, reproductive effects or problems in the major organs.

The recovery process takes a few weeks to months. During this period you will stay in the hospital to receive follow-up care which may include:

• Isolation in a germ-free room
• Antibiotics to prevent infection
• Blood transfusions
• Other medication to counter side effects
• Regular blood tests to monitor progress

The transplanted cells begin to populate your bone marrow. This process is called engraftment. In about 2-4 weeks, these stem cells grow into different cell types restoring your blood cells to safe levels.
Following the transplant you will receive maintenance therapy to prevent relapse and keep your cancer at remission

WHAT CAN YOU DO TO PREVENT INFECTION

Wash hands frequently

Bathe or shower each day with mild soap and water)

Ensure personal hygeine

Avoid raw or undercooked food

Get vaccinated for flu