I have been undergoing induction chemo since December 17, 2014, and with good results. According to the mSMART chart, I would be well advised to harvest and store my stem cells.
I have been debating if, at my age (soon to be 68), it would make sense for me to consider the transplant ordeal a few years from now. However, everyone around me has urged me to harvest and store my stem cells soon after the induction / consolidation therapy, at least as an insurance policy, should I need a transplant later.
In my recent visit, my oncologist said that there would be no need to harvest and store the stem cells, since the stem cells can be harvested later, just before a transplant (ASCT) at a later date! That was news to me, since I have been under the impression that one's stem cells would not be as 'healthy' at a later date, mainly due to the effects of years of chemo (maintenance levels).
I could not find discussion on this subject elsewhere, at least not in the few searches on this site and also on other search engines.
I hope to get some understanding of this 'later harvesting of stem cells' before I have further discussions with my oncologist on this subject.
K_Shash
Forums
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Delaying stem cell harvest for years after induction?
Hi K_Shash,
My husband started induction treatment about a month before you. His myeloma specialist gave as one of the primary reasons to harvest now, just after initial induction treatment, regardless of whether he goes for transplant early (which is what he will likely do), that some of the drugs (i.e., Revlimid) may make it more difficult to mobilize the stem cells, especially over time.
One other benefit we were given to harvest is that my husband will likely get Cytoxan (cyclophosphamide) as part of his pre-harvest protocol and this chemo has anti-myeloma properties, which could be beneficial as consolidation to induction and also as an indicator of how he may respond to melphalan.
My husband started induction treatment about a month before you. His myeloma specialist gave as one of the primary reasons to harvest now, just after initial induction treatment, regardless of whether he goes for transplant early (which is what he will likely do), that some of the drugs (i.e., Revlimid) may make it more difficult to mobilize the stem cells, especially over time.
One other benefit we were given to harvest is that my husband will likely get Cytoxan (cyclophosphamide) as part of his pre-harvest protocol and this chemo has anti-myeloma properties, which could be beneficial as consolidation to induction and also as an indicator of how he may respond to melphalan.
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EF11 - Who do you know with myeloma?: husband
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 43
Re: Delaying stem cell harvest for years after induction?
Hi K_Shash,
I am almost to the same decision. One myeloma expert told me to collect and store, but another one said that their clinic does not do that for several reasons: 1) storage, 2) insurance, 3) often they are never used. The doctor there also said that they never have a problem collecting stem cells before transplant, even for patients on Revlimid ... hmmmm ...
I plan to collect and store.
I am almost to the same decision. One myeloma expert told me to collect and store, but another one said that their clinic does not do that for several reasons: 1) storage, 2) insurance, 3) often they are never used. The doctor there also said that they never have a problem collecting stem cells before transplant, even for patients on Revlimid ... hmmmm ...
I plan to collect and store.
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Delaying stem cell harvest for years after induction?
Thanks, EF11 and gardengirl.
I am glad to hear that at least some other myeloma expert agrees that one can harvest the stem cells when needed, since this was the first time I ever heard of that.
K_Shash
I am glad to hear that at least some other myeloma expert agrees that one can harvest the stem cells when needed, since this was the first time I ever heard of that.
K_Shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Delaying stem cell harvest for years after induction?
Newly diagnosed multiple myeloma - as you are learning- is the beginning of a journey, for sure. It is not simple and, as you are experiencing, some of the management strategies are not as black and white as we would like. What is the right induction therapy? What about transplant? What about maintenance? ....
Generally, I recommend that, if a patient is transplant eligible (healthy and on the younger side for multiple myeloma - I generally have a soft cutoff of 75), consider high dose melphalan and autologous stem cell transplant (HDM-ASCT) as part of their initial line of therapy. This means you receive induction therapy (4-6 cycles), then get HDM-ASCT followed by maintenance therapy for some (if not most) patients.
The issue of early transplant (as just described above) vs delayed transplant (transplant after your first relapse, or at least 12 months later) remaisn somewhat controversial -- to the extent that, to answer this critical question, there is a large ongoing international trial, the so-called DFCI/IFM trial, in which a number of us are participating.
My interpretation of most of the data that exists today (ECOG subset analysis, Palumbo et al NEJM 2014), is that early transplantation provides benefit. However, there is also data stating that they are equivalent in long-term outcomes. One of the ways I look at it is that your marrow and health will be, in my opinion, best after induction therapy. As such, I recommend early HDM-ASCT.
BUT there is no wrong answer and many of my patients choose to delay.
Regarding collection and storage - This is sometimes dependent on your insurance. If possible, early collection and then storage is preferred, but with current medications, the concerns of not being able to collect in a delayed fashion are minimal. So, although not ideal, delayed collection should not be a large issue. However, no one can state that for sure.
I hope that this helps to some extent. Please let us know if you have further questions.
Generally, I recommend that, if a patient is transplant eligible (healthy and on the younger side for multiple myeloma - I generally have a soft cutoff of 75), consider high dose melphalan and autologous stem cell transplant (HDM-ASCT) as part of their initial line of therapy. This means you receive induction therapy (4-6 cycles), then get HDM-ASCT followed by maintenance therapy for some (if not most) patients.
The issue of early transplant (as just described above) vs delayed transplant (transplant after your first relapse, or at least 12 months later) remaisn somewhat controversial -- to the extent that, to answer this critical question, there is a large ongoing international trial, the so-called DFCI/IFM trial, in which a number of us are participating.
My interpretation of most of the data that exists today (ECOG subset analysis, Palumbo et al NEJM 2014), is that early transplantation provides benefit. However, there is also data stating that they are equivalent in long-term outcomes. One of the ways I look at it is that your marrow and health will be, in my opinion, best after induction therapy. As such, I recommend early HDM-ASCT.
BUT there is no wrong answer and many of my patients choose to delay.
Regarding collection and storage - This is sometimes dependent on your insurance. If possible, early collection and then storage is preferred, but with current medications, the concerns of not being able to collect in a delayed fashion are minimal. So, although not ideal, delayed collection should not be a large issue. However, no one can state that for sure.
I hope that this helps to some extent. Please let us know if you have further questions.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Delaying stem cell harvest for years after induction?
Hello K_Shash,
I hope all is going well for you. I have been away from most everything lately. My Mom passed away in January, so I have been working through everything. Mom was 94. Her Mom (my Grandma) lived to be 101. Figured I would be reaching that ole age also. Who knows?
Anyway, I just wanted to reply to your post. I decided a while back to do the cell harvest and storage to get me through a year or so of commitments before transplant. I just went to my SCT hospital for some pre admit information and to meet with a social worker. A few days before, I had a bone marrow biopsy which would be the real indication of how well my treatments had gone compared to a SPEP and IFE. While I was parking my car at the hotel where I was staying, my oncologist was calling and I wondered why.
They had to call me because the news was something I should be aware of. As they called it, I had a complete response from the treatments. But still shows 2%. As they put it, I was in the perfect time frame for my cell harvest.
I had my Cytoxan (cyclophosphamide) cocktail treatment last Friday and started Neupogen on Saturday, which will continue up to cell harvest this coming Monday. So far, no issues from the Cytoxan treatment and slight bone pain from the Neupogen. I am sure the pain will increase as the days go on, but I am staying positive no matter what. I stopped my Velcade treatments 3 weeks ago and just stopped my dexamethasone last week, as per the SCT hospital instructions. I can take Lyrica (pregabalin) for neuropathy. And Aleve for pain, if needed, up till the night before the central line is placed. Looking forward to having this completed.
I feel that everyone makes their best personal decision on the SCT. Mine just happens to be harvest and storage. Then transplant later. I feel it leaves me options. And maybe gives me some time that will show new treatments that I could have down this road.
Good Luck, Castaway.
I hope all is going well for you. I have been away from most everything lately. My Mom passed away in January, so I have been working through everything. Mom was 94. Her Mom (my Grandma) lived to be 101. Figured I would be reaching that ole age also. Who knows?
Anyway, I just wanted to reply to your post. I decided a while back to do the cell harvest and storage to get me through a year or so of commitments before transplant. I just went to my SCT hospital for some pre admit information and to meet with a social worker. A few days before, I had a bone marrow biopsy which would be the real indication of how well my treatments had gone compared to a SPEP and IFE. While I was parking my car at the hotel where I was staying, my oncologist was calling and I wondered why.
They had to call me because the news was something I should be aware of. As they called it, I had a complete response from the treatments. But still shows 2%. As they put it, I was in the perfect time frame for my cell harvest.
I had my Cytoxan (cyclophosphamide) cocktail treatment last Friday and started Neupogen on Saturday, which will continue up to cell harvest this coming Monday. So far, no issues from the Cytoxan treatment and slight bone pain from the Neupogen. I am sure the pain will increase as the days go on, but I am staying positive no matter what. I stopped my Velcade treatments 3 weeks ago and just stopped my dexamethasone last week, as per the SCT hospital instructions. I can take Lyrica (pregabalin) for neuropathy. And Aleve for pain, if needed, up till the night before the central line is placed. Looking forward to having this completed.
I feel that everyone makes their best personal decision on the SCT. Mine just happens to be harvest and storage. Then transplant later. I feel it leaves me options. And maybe gives me some time that will show new treatments that I could have down this road.
Good Luck, Castaway.
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Delaying stem cell harvest for years after induction?
Hi K_Shash,
I am dealing with similar questions. I am 54 and my oncology team supports the early transplant approach, but I'm not sure that I do, yet. The transplant center through the VA does not provide stem cell storage services for future use, so I would need to look at private insurance (which I don't yet have) for that option.
So much confusing and contradicting information out there - 'we think there may be evidence but we're not really sure'. I guess that is the nature of science and scientists.
Would be interested to know how your 'collect and store' plan goes. That seems like an approach that would open up more options for the future. I would like to do that, but it seems there will be a significant financial cost for that.
RT
I am dealing with similar questions. I am 54 and my oncology team supports the early transplant approach, but I'm not sure that I do, yet. The transplant center through the VA does not provide stem cell storage services for future use, so I would need to look at private insurance (which I don't yet have) for that option.
So much confusing and contradicting information out there - 'we think there may be evidence but we're not really sure'. I guess that is the nature of science and scientists.
Would be interested to know how your 'collect and store' plan goes. That seems like an approach that would open up more options for the future. I would like to do that, but it seems there will be a significant financial cost for that.
RT
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RadiantTiger - Name: Radiant Tiger
- Who do you know with myeloma?: Myself, my deceased uncle
- When were you/they diagnosed?: Feb 2015
- Age at diagnosis: 54
Re: Delaying stem cell harvest for years after induction?
Thank you Dr. Shain for your thoughtful and detailed advice.
My sincere apologies for having missed your post till just a few minutes ago. I do not know how this happened, since any activity in my 'topics' shows with blinking icons on my screen.
Thank you for clarifying that a delayed collection 'should not' be an issue.
I have had some activity in my other related post about my question "Stem Cell Harvest at 68 and Transplant at 75 - why bother?". However, this was a whole new question after my last monthly visit to my oncologist. Thanks again for taking time to address my concerns. I will continue to look for publications related to this concern.
Hello Castaway,
I am sorry to hear about your loss. I remember that you were not for / could not opt for an early transplant, as you were personally caring for your mother and could not take a few months off at the time for the ASCT. The loss of your mother must have been, therefore, quite hard on you as a long term care provider and please accept my sincere condolences.
The 2% plasma cell reading that you mentioned is fantastic. Though not applicable to me, I just came across the recent activity on the following (about plasma cells in the bone marrow before the harvest for ASCT):
"Myeloma cells in marrow at harvest for SCT," forum disc. started Mar 8, 2015
It would seem that a 4% reading is very good and your 2% ought to be near ideal! I wish you all the best to you and I hope you remain in the complete remission for a very long, long time.
Hello RT,
As you may have read in my opening post, I am not going to harvest my stem cells at all. As it is, I wasn't much for it in my specific case, considering my standard risk multiple myeloma (IgG kappa and trisomies only) and my age (soon to be 68).
At 54, however, I would certainly have liked to have had the option for harvest and storage for later transplant. Now Dr. Shain and my own oncologist have pointed out, a later harvest, just in time for a delayed transplant, seems to be a viable, too. Each case can be quite different and you may want to take into account all your risk factors, too.
Also, like the VA, Medicare apparently does not cover the stem cell storage costs, either. There was some discussion about that in another topic related to Medicare or stem cell harvest or delaying ASCT. I am not sure whether it was also mentioned in PeggyB's topic: "How did you decide to have an ASCT or not?" I hope you can find the post about how one may schedule an ASCT and cancel it after harvest, in the case of patients covered by Medicare, I am not sure if such a tactic would work.
In the mean time, I am trying to find supporting articles for my oncologist's opinion (confirmed by Dr. Shain) that one can delay the stem cell harvest altogether till you are ready for an ASCT.
K_Shash
My sincere apologies for having missed your post till just a few minutes ago. I do not know how this happened, since any activity in my 'topics' shows with blinking icons on my screen.
Thank you for clarifying that a delayed collection 'should not' be an issue.
I have had some activity in my other related post about my question "Stem Cell Harvest at 68 and Transplant at 75 - why bother?". However, this was a whole new question after my last monthly visit to my oncologist. Thanks again for taking time to address my concerns. I will continue to look for publications related to this concern.
Hello Castaway,
I am sorry to hear about your loss. I remember that you were not for / could not opt for an early transplant, as you were personally caring for your mother and could not take a few months off at the time for the ASCT. The loss of your mother must have been, therefore, quite hard on you as a long term care provider and please accept my sincere condolences.
The 2% plasma cell reading that you mentioned is fantastic. Though not applicable to me, I just came across the recent activity on the following (about plasma cells in the bone marrow before the harvest for ASCT):
"Myeloma cells in marrow at harvest for SCT," forum disc. started Mar 8, 2015
It would seem that a 4% reading is very good and your 2% ought to be near ideal! I wish you all the best to you and I hope you remain in the complete remission for a very long, long time.
Hello RT,
As you may have read in my opening post, I am not going to harvest my stem cells at all. As it is, I wasn't much for it in my specific case, considering my standard risk multiple myeloma (IgG kappa and trisomies only) and my age (soon to be 68).
At 54, however, I would certainly have liked to have had the option for harvest and storage for later transplant. Now Dr. Shain and my own oncologist have pointed out, a later harvest, just in time for a delayed transplant, seems to be a viable, too. Each case can be quite different and you may want to take into account all your risk factors, too.
Also, like the VA, Medicare apparently does not cover the stem cell storage costs, either. There was some discussion about that in another topic related to Medicare or stem cell harvest or delaying ASCT. I am not sure whether it was also mentioned in PeggyB's topic: "How did you decide to have an ASCT or not?" I hope you can find the post about how one may schedule an ASCT and cancel it after harvest, in the case of patients covered by Medicare, I am not sure if such a tactic would work.
In the mean time, I am trying to find supporting articles for my oncologist's opinion (confirmed by Dr. Shain) that one can delay the stem cell harvest altogether till you are ready for an ASCT.
K_Shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
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