[Lyrad]

SCT with 13 deletion & 17 translocation - good idea?

by Lyrad on Mon Sep 08, 2014 5:20 pm

I am a caregiver. My wife was diagnosed with multiple myeloma on April 14, 2014. She has stage 3, high risk multiple myeloma with 3 chromosome changes including 13 and 17.

She has just completed six cycles of VRD [Velcade, Revlimid, dexamethasone] as of September 2, 2014, and has responded well to the VRD treatment, going from an M-spike of 3.0 g/dL to 0.6 a few weeks ago. She is now no longer taking VRD and is scheduled for a final blood test and bone marrow biopsy on September 12, and we are moving towards an autologous stem cell transplant (SCT) as soon as the preparations are complete in the next couple of weeks.

My question concerns the following comment that I read at the MMRF website:

“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.

Does anyone have any thoughts / information regarding the above comments?

Thank You,

[Jonah]

Re: SCT with 13 deletion & 17 translocation - good idea?

by Jonah on Mon Sep 08, 2014 6:03 pm

Hi Lyrad,

If you haven't already seen this article, you might want to check it out. It suggests that transplantation may be a reasonable choice for high-risk myeloma patients if it is combined with a consolidation and maintenance treatment plan:

"Extended Post-Transplant Treatment With Revlimid, Velcade, And Dexamethasone Yields High Survival Rates In High-Risk Myeloma (Emory University Study)," The Myeloma Beacon, November 26, 2013.

Best of luck to your wife.

[JBarnes]

Re: SCT with 13 deletion & 17 translocation - good idea?

by JBarnes on Mon Sep 08, 2014 10:51 pm

Deletion 13p is not considered high risk according to my oncologist.

[Debbie W]

Re: SCT with 13 deletion & 17 translocation - good idea?

by Debbie W on Tue Sep 09, 2014 3:50 am

Hi Lyrad,

I am in a similar situation. My mom is also high risk. I did find that article about the Emory study being done by Dr. Lonial and his colleagues to be helpful.

It is a very hard situation to try to make the right decisions. My mom is almost 72 and I am concerned on how well she will be able to handle the SCT. I am wondering if there are other high-risk long term survivors that are older and what plan they followed.

This disease is so tricky how it keeps coming back, I just keep praying for a cure. Thankfully for all the new drugs there has been great progress unfortunate the hard side effects.

I will keep your wife in my prayers along with all the other courageous multiple myeloma patients. Good luck to you and please keep us posted.

Thanks for your input.

[rumnting]

Re: SCT with 13 deletion & 17 translocation - good idea?

by rumnting on Tue Sep 09, 2014 8:10 am

Lyrad,

My husband is also 13- and 17-. He had the same induction treatment as your wife, followed by an auto transplant. He had his transplant 3 years ago. He has felt well since then and lived an active life. He is relapsing now, and we should know the new plan this week.

He was pretty sick during the transplant, and with all the doom and gloom high risk stuff we had read about pre-transplant, I at the time wondered if it was even worth going through. It most definitely was. If another transplant is recommended, he will do it again in a heart beat.