Forums
10 posts
• Page 1 of 1
"Mini" Allo vs Allo
Would someone happen to know the difference? I would imagine that a "mini" minimizes the morbidity?
-
habubrat - Name: Lori
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2008
- Age at diagnosis: 48
Re: "Mini" Allo vs Allo
Hi Lori,
A mini-allo transplant (also known as a reduced-intensity or non-myeloablative allogeneic stem cell transplant) is one in which the conditioning regimen used to kill off the patient's cells in the bone marrow prior to stem cell transplantation doesn't fully kill off all of the bone marrow cells. The donor stem cells will then be mixed in with the patient's cells.
You're right that mini-allo transplants are associated with better tolerability / less mortality than the full allo transplants. But survival seems to be similar between auto, mini-allo-, and allo transplants, so autologous transplants are recommended for the majority of myeloma patients. Mini or full allos are generally only used in the clinical trial setting and are generally reserved for myeloma patients who have relapsed multiple times or who have not responded to several treatments.
Here's more information about mini and full allo transplants: https://myelomabeacon.org/news/2010/09/13/experts-recommend-against-donor-stem-cell-transplantation-for-multiple-myeloma-patients-until-safety-and-efficacy-is-improved/
A mini-allo transplant (also known as a reduced-intensity or non-myeloablative allogeneic stem cell transplant) is one in which the conditioning regimen used to kill off the patient's cells in the bone marrow prior to stem cell transplantation doesn't fully kill off all of the bone marrow cells. The donor stem cells will then be mixed in with the patient's cells.
You're right that mini-allo transplants are associated with better tolerability / less mortality than the full allo transplants. But survival seems to be similar between auto, mini-allo-, and allo transplants, so autologous transplants are recommended for the majority of myeloma patients. Mini or full allos are generally only used in the clinical trial setting and are generally reserved for myeloma patients who have relapsed multiple times or who have not responded to several treatments.
Here's more information about mini and full allo transplants: https://myelomabeacon.org/news/2010/09/13/experts-recommend-against-donor-stem-cell-transplantation-for-multiple-myeloma-patients-until-safety-and-efficacy-is-improved/
Re: "Mini" Allo vs Allo
This is contrary to what I am being told at the hospital where I have had four rounds of Mini-allo transplant from my brother. As to the comment about a conditioning regimen, there is no pre-transplant regimen at all, at least not with my four transplants. There was no chemo or radiation before the cells were given, unlike my auto and allo I had previously.
I was advised the risk was no less but the same as full allo transplant. In addition I have not had any relapse experience and have responded to all treatments prior to my mini-allo. This was offered to me because I have done well, 5 years since transplants with no relapse and that this is what made me a good candidate. Additionally I was told that this is very slow in providing response, 4 months to a year, and because of that is not recommended for relapse or saving someone!
Not wanting to be contrary but this is my experience and as has been shared here before, there is no absolute script for multiple myeloma treatments. Add to that we are all different, can respond differently, and mini-allo is considered research in application.
Hugh
I was advised the risk was no less but the same as full allo transplant. In addition I have not had any relapse experience and have responded to all treatments prior to my mini-allo. This was offered to me because I have done well, 5 years since transplants with no relapse and that this is what made me a good candidate. Additionally I was told that this is very slow in providing response, 4 months to a year, and because of that is not recommended for relapse or saving someone!
Not wanting to be contrary but this is my experience and as has been shared here before, there is no absolute script for multiple myeloma treatments. Add to that we are all different, can respond differently, and mini-allo is considered research in application.
Hugh
-
turbineman - Name: Hugh
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Jan 2006
- Age at diagnosis: 61
Re: "Mini" Allo vs Allo
Hi Turbineman
Please help me understand more what you mean, as you say:
"There was no chemo or radiation before the cells were given, unlike my auto and allo I had previously. I was advised the risk was no less but the same as full allo transplant. In addition I have not had any relapse experience and have responded to all treatments prior to my mini-allo."
Why are you having multiple transplants, if you are not relapsing? You did have melphan prior to auto and allo transplant? But no lenalidomide / dex / bortezomib nor melphalan prior to mini?
You also write:
"This was offered to me because I have done well, 5 years since transplants with no relapse and that this is what made me a good candidate."
Did you go 5 years between the auto and the allo transplant without relapsing? Did you achieve CR following the auto transplant? Why did they decide to do the allo transplant 5 years later without you having relapsed?
Additionally you say:
"Additionally I was told that this is very slow in providing response, 4 months to a year, "
Are you saying that you can get a response up to a year later from an allo? How does that response time differ from what is expected with an auto? Also what criteria do they use for determing a response to transplant?
Also, have you ever received any drugs to treat your myeloma whatsoever? Because you say:
" there is no pre-transplant regimen at all, at least not with my four transplants."
Lastly, would mind sharing or be kind enough to share what institution is this?
Thanks Hugh.
suzierose
Please help me understand more what you mean, as you say:
"There was no chemo or radiation before the cells were given, unlike my auto and allo I had previously. I was advised the risk was no less but the same as full allo transplant. In addition I have not had any relapse experience and have responded to all treatments prior to my mini-allo."
Why are you having multiple transplants, if you are not relapsing? You did have melphan prior to auto and allo transplant? But no lenalidomide / dex / bortezomib nor melphalan prior to mini?
You also write:
"This was offered to me because I have done well, 5 years since transplants with no relapse and that this is what made me a good candidate."
Did you go 5 years between the auto and the allo transplant without relapsing? Did you achieve CR following the auto transplant? Why did they decide to do the allo transplant 5 years later without you having relapsed?
Additionally you say:
"Additionally I was told that this is very slow in providing response, 4 months to a year, "
Are you saying that you can get a response up to a year later from an allo? How does that response time differ from what is expected with an auto? Also what criteria do they use for determing a response to transplant?
Also, have you ever received any drugs to treat your myeloma whatsoever? Because you say:
" there is no pre-transplant regimen at all, at least not with my four transplants."
Lastly, would mind sharing or be kind enough to share what institution is this?
Thanks Hugh.
suzierose
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: "Mini" Allo vs Allo
Hugh,
When you say 4 mini-allo transplants with no conditioning regimens, are you referring to donor lymphocyte infusions?
https://myelomabeacon.org/news/2012/02/17/preemptive-donor-lymphocyte-infusions-multiple-myeloma/
When you say 4 mini-allo transplants with no conditioning regimens, are you referring to donor lymphocyte infusions?
https://myelomabeacon.org/news/2012/02/17/preemptive-donor-lymphocyte-infusions-multiple-myeloma/
-
Jack
Re: "Mini" Allo vs Allo
Jack,
The first paragraph in the article you attached is exactly what my situation was prior to Mini-allo. I had residual disease. I have never gotten to zero as they say. Always still have a low number in M-protein spike at testing. It was 5 years since my auto and allo transplants. I had had maintenance chemo during that time, most of it on Dex alone. In March 2011 all treatment was stopped and I was given the four Mini-allo IV of my brother's cells. No prep with chemo or radiation, as was done with my 2006 auto/allos.
This is done under a research protocol so I don't suggest that this is standard approach in any way. This was done at MD Anderson Cancer Center in Houston Texas.
Hugh
The first paragraph in the article you attached is exactly what my situation was prior to Mini-allo. I had residual disease. I have never gotten to zero as they say. Always still have a low number in M-protein spike at testing. It was 5 years since my auto and allo transplants. I had had maintenance chemo during that time, most of it on Dex alone. In March 2011 all treatment was stopped and I was given the four Mini-allo IV of my brother's cells. No prep with chemo or radiation, as was done with my 2006 auto/allos.
This is done under a research protocol so I don't suggest that this is standard approach in any way. This was done at MD Anderson Cancer Center in Houston Texas.
Hugh
Last edited by turbineman on Fri Feb 24, 2012 9:02 pm, edited 1 time in total.
-
turbineman - Name: Hugh
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Jan 2006
- Age at diagnosis: 61
Re: "Mini" Allo vs Allo
Suzie,
I will try to answer your questions as best I can. Please know I am just trying to share what and how it was done to me a MD Anderson Cancer Center in Houston Texas. I went there because they have such a large staff dedicated to Multiple Myeloma.
The five years is since both my auto/allo major transplants, not betwen them. I did not achieve CR as some say and still had activity numbers, although they got quite low. I had Thalidomide for a year as chemo maintenance but stopped due to the severness of neuropathy damage. I then took Dexamethasone for the rest of four years up to March 2011 when I started Mini-allo treatment, it was stopped at that time. There was no pre-conditioning regime for my mini-allo treatments. No chemo or radiation prior to.
They offered this to me due to doing well, and in an effort to further reduce my residual numbers and try for zero. Presently I am on no chemo. By the way a Mini-allo in my case were each 50 million of my brother's stem cell. Sounds big but it is one IV bag!
Note that I am 67 years old now and I am pleased that they will continue to take an agressive approach to my treatment, even at my age.
As to response, they advise that improvement can start 2 to 4 months later, and improvement effect can still be gained a year later. Slow improvement and not for relapse or recovery is what I was told.
I hope my experience is helpful, at the least in adding some understanding. How Mini-allo compares to full allo as to results, I have no idea.
Hugh
I will try to answer your questions as best I can. Please know I am just trying to share what and how it was done to me a MD Anderson Cancer Center in Houston Texas. I went there because they have such a large staff dedicated to Multiple Myeloma.
The five years is since both my auto/allo major transplants, not betwen them. I did not achieve CR as some say and still had activity numbers, although they got quite low. I had Thalidomide for a year as chemo maintenance but stopped due to the severness of neuropathy damage. I then took Dexamethasone for the rest of four years up to March 2011 when I started Mini-allo treatment, it was stopped at that time. There was no pre-conditioning regime for my mini-allo treatments. No chemo or radiation prior to.
They offered this to me due to doing well, and in an effort to further reduce my residual numbers and try for zero. Presently I am on no chemo. By the way a Mini-allo in my case were each 50 million of my brother's stem cell. Sounds big but it is one IV bag!
Note that I am 67 years old now and I am pleased that they will continue to take an agressive approach to my treatment, even at my age.
As to response, they advise that improvement can start 2 to 4 months later, and improvement effect can still be gained a year later. Slow improvement and not for relapse or recovery is what I was told.
I hope my experience is helpful, at the least in adding some understanding. How Mini-allo compares to full allo as to results, I have no idea.
Hugh
-
turbineman - Name: Hugh
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Jan 2006
- Age at diagnosis: 61
Re: "Mini" Allo vs Allo
Thanks Hugh!!
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: "Mini" Allo vs Allo
Hugh,
Your mindset is awesome - an Allo in your early 60's. How did your Tandem Auto-Allo go for you? I found that I had worse side effects from all the Chemo that I used prior to the Allo than from the Transplant itself.
I think your Doctor is great as well. They actually thought of doing something other than Velcade/Revlimid/Dex and Auto transplants. We need some innovative thinking in the Myeloma world.
I got the level of Remission my Doctor wanted from my Allo so I am not treating currently. Please keep us up to date on how your current treatment goes. That is next up on my treatment list and I do not read a whole lot of experiences about doing them.
Keep up that fighting spirit.
Mark
Your mindset is awesome - an Allo in your early 60's. How did your Tandem Auto-Allo go for you? I found that I had worse side effects from all the Chemo that I used prior to the Allo than from the Transplant itself.
I think your Doctor is great as well. They actually thought of doing something other than Velcade/Revlimid/Dex and Auto transplants. We need some innovative thinking in the Myeloma world.
I got the level of Remission my Doctor wanted from my Allo so I am not treating currently. Please keep us up to date on how your current treatment goes. That is next up on my treatment list and I do not read a whole lot of experiences about doing them.
Keep up that fighting spirit.
Mark
-
Mark
Re: "Mini" Allo vs Allo
Mark,
I agree with your experience, the Malphalen prior to my auto was the worst of it. For the allo three months later, I had whole body radiation for the prep. This also made me sick but was tolerable. For most of the five years following the auto/allo I have been treated with monthly Dex, forty pills the first four days of the month. Now that is a scary trip as has been discussed elsewhere in the Beacon. With the mini-allo I just completed I am now on no maintenance chemo since March 2011. Numbers are low but still there each month when checked.
Good luck to you too Mark, on this difficult journey
Hugh
I agree with your experience, the Malphalen prior to my auto was the worst of it. For the allo three months later, I had whole body radiation for the prep. This also made me sick but was tolerable. For most of the five years following the auto/allo I have been treated with monthly Dex, forty pills the first four days of the month. Now that is a scary trip as has been discussed elsewhere in the Beacon. With the mini-allo I just completed I am now on no maintenance chemo since March 2011. Numbers are low but still there each month when checked.
Good luck to you too Mark, on this difficult journey
Hugh
-
turbineman - Name: Hugh
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Jan 2006
- Age at diagnosis: 61
10 posts
• Page 1 of 1
Return to Treatments & Side Effects