There are numerous different cancers that may affect a person’s blood cells. One type of blood cancer is multiple myeloma, a cancer of the white blood cells and more specifically a person’s plasma cells. Plasma cells are integral to how a person’s immune system responds to a wide range of challenges. Impairments of plasma cells, such as those caused by cancer, can leave people prone to a host of problems, including fatigue, lethargy, and recurrent infections. Some of these consequences can even be deadly. In its simplest terms, a patient with multiple myeloma simply lacks the necessary energy for normal healthy body functions.
According to the American Cancer Society, multiple myeloma is one of the rarer cancers, just over 30,000 people are diagnosed each year. Interestingly, and for reasons that are not entirely known, men are more likely to be diagnosed with multiple myeloma than women. There are other factors that may raise the risk of developing multiple myeloma. For example, the risk of developing this disease increases with age, and African Americans are more likely than their white peers to develop multiple myeloma. Again, the reasons for these elevated risks are not fully understood. More research still needs to be carried out into multiple myeloma.
Treating Multiple Myeloma
Unlike many types of cancers for which there are standard treatment protocols, multiple myeloma treatment plans vary dramatically from patient to patient, depending on various factors, such as: the patient’s age and his/her overall health. There are many different ways of treating multiple myeloma, ranging from taking a wait-and-see approach to intensive interventions. One intensive interventional approach that has proven to be highly successful in some patients is a stem cell transplant.
An Option: Stem Cell Transplant
However, a stem cell transplant may not be the right answer for everyone! Prior to moving down the stem cell transplant route, doctors will need to complete a comprehensive evaluation to determine if a patient is a good candidate for this transplant. The decision will be made by looking at best practice protocols, while simultaneously assessing the person’s health, including: his/her age and any other complicating health conditions that he/she may have in addition to the multiple myeloma. For example, all else equal, a younger and healthier patient may be a better candidate for a stem cell transplant than an older patient or one who is frail or medically compromised.
Being Selected as a Candidate
Once a doctor has determined that a patient is a good candidate for a stem cell transplant, the medical team will then have to find a suitable donor for the stem cells. In general, the outcomes for stem cell transplants are better when there is a related donor, such as a sibling. However, unrelated, but carefully matched donors can also be successfully used in many cases. Another option is for the patient to serve as his/her own donor. In this case, the patient’s own stem cells are used in what is medically referred to as an autologous transplant. However, unlike other types of stem cell transplants that can potentially cure multiple myeloma, these autologous transplants only result in remissions, although the length of the remission can vary dramatically. Also, these autologous bone marrow transplants often require tandem transplants. What is a tandem transplant? A tandem transplant occurs when a person has two transplants within a relatively short period of time (often less than a year). Clearly, these tandem transplants may place more stress on a person’s body and increase dangers and complications.
The Risks of Stem Cell Transplants
It is important to remember that it is not just autologous, and particularly tandem, transplants that have certain risks associated with them. All stem cell transplants carry certain risks with them. Prior to a stem cell transplant, people receive high dose radiation and chemotherapy. These treatments are designed to kill off unhealthy and cancerous bone marrow cells. But, these treatments do not discriminate … they also kill off healthy cells. The lack of functioning bone marrow cells may leave people susceptible to potentially deadly infections.
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Another risk associated with stem cell transplants is something that is known as Graft-versus-Host Disease. What is Graft-versus-Host? Graft-versus-Host Disease is a complication that may present itself when a person receives stem cells from a donor other than himself/herself. In this case, the stem cells see the patient’s own body and tissue as a foreign invader. Statistics are somewhat unclear on how many people are actually impacted by Graft-versus-Host Disease. But, statistics and anecdotal evidence suggest that it is not an insignificant number of patients. Also, the severity of the impact of Graft-versus-Host can vary dramatically from patient to patient. Generally, Graft-versus-Host in its acute form will present as a severe full body rash and patients may also have GI and liver symptoms.
Often, these concerns can be resolved with quick and appropriate interventions. But, sometimes acute Graft-versus-Host develops into chronic Graft-versus-Host, in which the Disease will target various organs and symptoms of the body. Sometimes, the consequences of this attack will be that the organ(s) will simply stop functioning, and in severe cases, it may even lead to death. Recognizing the significant risks posed by this problem, doctors are continuing to look for answers, including continuing to upgrade the matching process between donor and recipient. This is important, because statistics suggest that certain measurable factors may influence the likelihood of developing Graft-versus-Host Disease, such as advanced age of either the donor or the recipient. Also, the risk rises significantly if a woman donates stem cells to a man.
Understand The Potential Risks
The above-mentioned risk factors do not mean that stem cell transplants should not continue to be used as a go-to treatment option for patients with multiple myeloma. Instead, it simply means that doctors need to be cognizant about the potential risk factors and be prepared to respond proactively to any concerns that may exist. Also, it means that patients should be fully informed and educated about risk factors so that they can offer full consent to this treatment. It also means that research needs to continue into both what factors elevate the risk of developing Graft-versus-Host Disease, and how Graft-versus-Host Disease can be more effectively treated if it does develop.
Multiple myeloma is a relatively rarely diagnosed cancer of a patient’s white blood cells, and more specifically, the patient’s plasma cells. This cancer may negatively impact the patient’s energy levels and may leave them susceptible to a wide variety of immune system challenges. Although multiple myeloma can affect anyone, it is most commonly seen in older patients, as well as men and African Americans. The reasons behind these differentiated risk levels is not entirely known, as of yet. As with many cancers, there are multiple treatment modalities that may be used to effectively treat a patient. One such option is stem cell transplants from the patient himself or herself or from another donor (either related or unrelated). Even though stem cell transplants are effective and life-changing for many people, there are certain risks associated with the procedure, such as leaving a person vulnerable to an opportunistic infection or leading to the development of Graft-versus-Host Disease. Given these risks, it is important that patients carefully discuss the benefits and risks of this treatment approach with their provider.
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