Autologous Hematopoietic Stem Cell Transplantation for Patients With Multiple Myeloma

Abstract

Autologous hematopoietic stem cell transplantation (AHSCT) is approved for the treatment of select solid tumors, autoimmune disorders, and most hematologic malignancies. Multiple myeloma (MM) is the most common indication for AHSCT. Despite improvement in response and survival rates in the era of novel agents, AHSCT remains an important treatment option for patients with MM who are eligible. Clinical management of patients with MM requires a multidisciplinary approach that incorporates healthcare professionals in a number of clinical settings as well as caregivers and the patient. Patients about to undergo AHSCT are generally referred to tertiary care centers that specialize in ASCT. Pre- and post-transplantation treatments and long-term follow-up often are managed by a community-based referring oncologist in collaboration with the transplantation team. Oncology nurses play an integral role in the care of patients with MM in each clinical setting. This article aims to provide non-transplantation oncology nurses with guidelines for education, clinical management, and support of patients with MM undergoing AHSCT with a primary focus on the pre- and post-transplantation period.

Clinical Updates in Blood and Marrow Transplantation in Multiple Myeloma

“…Anticipated side effects and other pre-engraftment complications are discussed in the following sections. An overview of common side effects associated with MM therapies and post-transplantation symptoms also can be found in Tables 1 and 2 on pages 17 and 19 in Miceli et al (2013).…”

“…Pre-engraftment pulmonary complications include pulmonary edema, bronchiolitis obliterans, and pneumonia (Blombery et al, 2011). Common organisms causing pneumonia are listed in Table 3 of Miceli et al (2013) on page 20 of this supplement.…”

“…In particular, the prolonged use of melphalan should be avoided in patients eligible for transplantation (Cavo et al, 2011;Giralt et al, 2009). Possible pretransplantation combinations for induction therapy are outlined in Miceli et al (2013) and will not be discussed here.…”

“…Based on information from Miceli et al, 2013;Pallera & Schwartzberg, 2004;Tuncer et al, 2012. The source of the problem often is linked to nephrotoxic medication such as antibiotics, antihypertensives, chemotherapy, or antifungal agents. Acute renal failure from tubular necrosis may develop.…”

“…Long-term side effects and complications can occur and require the attention of community-based practitioners, as well. This article will cover considerations within each phase, with a focus on autologous hematopoietic stem cell transplantation (AHSCT) and should be used in conjunction with the Miceli et al (2013) article in this supplement to get a broad picture of the transplantation experience. Allogeneic transplantation, © tagota/iStock/Thinkstock which should only be considered in the context of a clinical trial, is highlighted in the "Special Interest" sidebar on page 35.…”