The role of high-dose chemotherapy supported by hematopoietic stem cell transplantation in patients with multiple myeloma: implications for nursing

Abstract

Multiple myeloma (MM), a neoplastic proliferation of plasma cells originating from the B-cell line, is associated with deleterious complications and poor outcomes. The failure of conventional combination chemotherapies to improve the overall survival of patients with MM has led to the use of high-dose chemotherapy supported by stem cell transplantation (SCT). Although several novel therapies have emerged since the late 1990s, their survival benefits are undetermined. High-dose chemotherapy with SCT provides better response rates compared to conventional chemotherapy and yields a trend toward greater survival benefits, especially with the use of a tandem (two successive) transplantation strategy. This article discusses standard SCT in patients with MM and some of the new transplantation strategies, including tandem autologous SCTs and reduced-intensity nonmyeloablative allogeneic SCT, and their implications for nursing.

Figure 1. Primary Conventional Chemotherapies for Multiple Myeloma

Note. Based on information from National Comprehensive Cancer Network, 2005; Palumbo et al., 2005.

Figure 2. Evaluation of Patients With Multiple Myeloma Prior to Autologous Stem Cell Transplantation

Note. Based on information from Foundation for the Accreditation of Hematopoietic Cell Therapy, 1997; Kapustay & Buchsel, 2005; National Comprehensive Cancer Network, 2005; Niess & Duffy, 2004.

Figure 3. Basics of Stem Cell Collection

Note. Based on information from Letheby et al., 2005; Schmit-Pokorny, 2004.

Figure 4. Stem Cell Reinfusion Procedure

Note. Based on information from American Association of Blood Banks et al., 2005.