Who is a Candidate for High-Dose Chemotherapy?
High-dose radiation therapy candidates must consider numerous factors before undergoing treatment. These include:
- The type of myeloma
- The stage of disease and how aggressive it is
- How the cancer responded to prior treatment
- Age and general physical condition
In the past, transplants were limited to younger patients in good physical condition. However, they are now performed in a more diverse group of patients. In general, patients in overall good physical condition with adequate kidney, lung, and heart function are eligible.
In addition, recent studies have shown that high-dose chemotherapy and stem cell transplant may even be possible in patients who have reduced kidney function or kidney failure, with proper precautions and somewhat lower doses of chemotherapy.
- Transplant may not be feasible in patients who have received:
- Certain types of chemotherapy, especially melphalan
- Radiation therapy to the spine or pelvis
These treatments may impact the ability to obtain the stem cells needed for the transplantation.
Although it seems counter-intuitive, some experts do not recommend high-dose chemotherapy and stem cell transplant for patients who have some types of high risk disease, which accounts for approximately 25% of myeloma patients. High-risk patients include those with certain types of DNA abnormalities (e.g. chromosome 13 deletion, chromosome 17 translocation). These patients tend to have shorter periods of remission. Further, one study showed there may actually be poorer survival.
You and your doctor will determine if high-dose chemotherapy and stem cell transplant is right for you.