When you learn that you have a multiple myeloma diagnosis, your care team may discuss something called an ACST, which is an acronym for an “autologous stem cell transplant.” This is a common treatment option for many people with multiple myeloma.
Let’s explore what this type of stem cell treatment is and how it might affect your care plan.
Autologous means the stem cells come from your own body. Stem cells are cells made in the bone marrow that grow into healthy blood cells (for example, red cells, white cells, and platelets). A transplant means those stem cells are returned to your body after treatment. An ACST is unique because it uses your own stem cells, rather than a donor’s.
How does an ACST work?
An ACST happens in several stages, usually over a few months.
Stage 1: Induction therapy (Before the transplant). You’ll first receive medications to treat the myeloma as much as possible. This is often a combination of different drugs.
Stage 2: Stem cell collection. Your stem cells are collected from your blood using a process called apheresis, similar to donating blood or platelets, through a blood draw. The cells are then frozen and stored safely.
Stage 3: High-dose chemotherapy. You’ll receive a high dose of chemotherapy, usually melphalan. This dose will be strong enough to destroy the remaining myeloma cells, but it can also destroy healthy bone marrow.
Stage 4: Stem cell transplant. Your previously collected stem cells are infused back into your bloodstream. They travel to the bone marrow and begin rebuilding your blood and immune system.
Stage 5: Recovery. Following the transplant, you may experience a variety of side effects as your blood count slowly recovers. For example, fatigue is a very common symptom. There’s also a greater risk of infection, so many patients who undergo this procedure stay in the hospital or close to the transplant center as they recover.
Why do doctors rely upon ACST in multiple myeloma?
Multiple myeloma affects plasma cells in the bone marrow. While treatments like chemotherapy, targeted therapy, and immunotherapy can control the disease, they typically don’t cure it. Oncologists rely on ACST to deepen the response after initial treatment, reduce the amount of myeloma in the body, and help patients stay in remission for longer periods of time.
It’s important to be aware that an ACST doesn’t represent a cure, but it has been proven to increase progression-free survival in patients with multiple myeloma.
Are all multiple myeloma patients eligible for an ACST?
Not everyone with multiple myeloma ends up pursuing an ACST. Oncologists typically consider a patient’s overall health and fitness, their current primary organ function, and how their myeloma originally responds to treatment. While age does play a role, many patients in their 60s or 70s are also eligible if they’re generally healthy.
Below are some questions you can bring to your care team if you’re wondering if an ACST is right for you:
How do my age, overall health, and organ function affect my eligibility?
What are the risks and side effects? What should I expect during high-dose chemotherapy, the transplant, and recovery?
How will my blood counts and immune system be monitored?
If I am not eligible for an ACST, what other options exist?
How does an ACST affect my long-term prognosis?
What happens after the ACST?
After recovery, many patients start maintenance therapy, often with a lower-dose medication. Patients continue to undergo regular monitoring from their care team. While some people return to their “regular life” within a few months, other patients need a longer recovery to rebuild their energy.
Connect with other patients with multiple myeloma who have chosen an ACST in our Outcomes4Me Community.
