Hello to all!
I am a 22 year old female from the Midwest who was diagnosed with multiple myeloma on January 2012. My diagnosis came about after breaking my T11 vertebrae on 1/7/12 and thus having to receive a spinal fusion surgery where 2, 8 inch rods and 8 screws were used to fuse vertebrae’s T9-L1. Doctors were puzzled as to why my vertebrae would have just shattered, so further tests were conducted. It was a plasmacytoma which eroded the bone away, and a blood test revealed an M-spike of 0.9. A bone survey also showed other areas of bone affected. (I could elaborate on and on, but am just providing the main facts so-to-speak.)
Otherwise a healthy and active young adult, I was completely shocked to hear this news. I received radiation in Feb. 2012 and held off from further treatment since 2 bone marrow biopsies came back normal. However, the third biopsy revealed about 30% plasma cell involvement, so on July 6, 2012 I began a combo of Velcade and Dex. I did this for 3 cycles, but did not see any drop in my M-spike. Therefore, my doctor added Revlimid and I just started my third cycle of the VRD combo. Praying that this will work for me! After treatment, a transplant is planned. Still determining which type to do…auto vs. allo (my 16yr old sister is a perfect match!!); however I do understand the risks of the allo are much greater. So, this has been a big objective for me lately, determining which transplant will be in my best interest. I believe we are planning to do the transplant sometime in early January.
Just when I was feeling like my life was crashing down, I knew I had the choice to sit and worry, or to make the most of each and every day that God has blessed me with. Since my diagnosis with multiple myeloma in January 2012 life has never been the same. No, it has not been all bad, as I have grown as a person both spiritually and mentally. God is my rock and my faith, family, and friends have all pulled me through everything thus far. My outlook since the diagnosis has been positive. I approach each day as a blessing from God and realize that life is too short to take anything for granted. And no matter what I may have to face in the future, I know that I will never be fighting alone.
God Bless!
Forums
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wrkoutgrly - Name: D'Ann
- Who do you know with myeloma?: I have Multiple Myeloma
- When were you/they diagnosed?: January 2012
- Age at diagnosis: 22
Re: 22 year old female with Multiple Myeloma
I am so sorry about your diagnosis, but that you have your faith to lean on. Since my husband's diagnosis, I don't know where we would be without it. You didn't say where you are receiving your treatment. We are in the Midwest as well and I can't say enough good things about the Simon Cancer Center in Indianapolis.
I think if I was your age, I would definitely go with the auto transplant and hold the allo card for another day if you need to.
Hang in there and stay strong. Praying along with you for a cure.
I think if I was your age, I would definitely go with the auto transplant and hold the allo card for another day if you need to.
Hang in there and stay strong. Praying along with you for a cure.
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Marie64 - Name: Marie
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 45
Re: 22 year old female with Multiple Myeloma
Hi wrkoutgrly -
I'm sorry for your diagnosis and the pain you have suffered. Like you, I suffered from a compression fracture of my T10 in December of 2010 caused from a plasmacytoma. After many tests and biopsies, I was diagnosed with Multiple Myeloma in February 2011. I was 55 years old at diagnosis.
I received 12 radiation treatments to shrink the tumor in my spine, which greatly reduced the pain I was having. Following the radiation treatments, I had six cycles of the VRD combo. In August 2011 I underwent induction therapy to prepare for my SCT in November. The induction chemo included cytoxin on 10/6/12. On October 17 I had my own stem cells harvested to use in my autologous stem cell transplant. On October 23 I started losing my hair. On October 31, I started my first of two infusions of malphalan and on November 1 I had my second infusion. I had a day of rest on November 2 and on November 3, I had my transplant. Finally, in February of 2012 I was able to have a cementing procedure called "Kyphoplasty" to stabilize my spine as I was still having residual pain from the fracture.
After my initial diagnosis, I went to Massachusetts General Hospital for recommendation on treatment and I am so glad I did. They are so wonderful. I don't know where I would be had I not gone for a second opinion.
My life has not been the same. I frequently miss the "old" days, but try and keep everything in prospective. I'm still able to get out and golf and I now am able to bowl again after a two year break. I am feeling fortunate that I can enjoy life and I commend your attitude. Keep up the fight and know that you are not alone.
Take care!
I'm sorry for your diagnosis and the pain you have suffered. Like you, I suffered from a compression fracture of my T10 in December of 2010 caused from a plasmacytoma. After many tests and biopsies, I was diagnosed with Multiple Myeloma in February 2011. I was 55 years old at diagnosis.
I received 12 radiation treatments to shrink the tumor in my spine, which greatly reduced the pain I was having. Following the radiation treatments, I had six cycles of the VRD combo. In August 2011 I underwent induction therapy to prepare for my SCT in November. The induction chemo included cytoxin on 10/6/12. On October 17 I had my own stem cells harvested to use in my autologous stem cell transplant. On October 23 I started losing my hair. On October 31, I started my first of two infusions of malphalan and on November 1 I had my second infusion. I had a day of rest on November 2 and on November 3, I had my transplant. Finally, in February of 2012 I was able to have a cementing procedure called "Kyphoplasty" to stabilize my spine as I was still having residual pain from the fracture.
After my initial diagnosis, I went to Massachusetts General Hospital for recommendation on treatment and I am so glad I did. They are so wonderful. I don't know where I would be had I not gone for a second opinion.
My life has not been the same. I frequently miss the "old" days, but try and keep everything in prospective. I'm still able to get out and golf and I now am able to bowl again after a two year break. I am feeling fortunate that I can enjoy life and I commend your attitude. Keep up the fight and know that you are not alone.
Take care!
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Lisa_G
Re: 22 year old female with Multiple Myeloma
D'Ann,
Prayers are going out your way! I was in my early 40's at diagnosis and I thought that was young. I did an allo as soon as I got to my first CR and it was the best decision I ever made. I did not look at it as auto vs allo - the two really have little in common. An auto is just a high dose of drugs (usually melphalan) and your stem cells are given back to you so you can recover. An allo is giving the patient a donor immune system that has the potential to cure the disease. Risk is a little higher, but the reward is much greater - potential cure! I really looked at it as allo vs maintenance therapy.
The main thing that makes the allo riskier is getting chronic GVHD (graft vs host disease). You should ask your Doctor if he/she uses ATG (antithymocyte globulin). The chance of having extensive chronic GVHD is quite low if ATG is used prior to transplant. It is typically used for 3 days prior to recieving the Donor cells.
IMO to "hold the allo card for another day " is poor advice if you look at the statistics. This study shows how much better allos work if they are done as part of planned early therapy as opposed to in a relapsed setting.
https://ash.confex.com/ash/2011/webprogram/Paper37067.html
Relapse from an auto makes the allo less likely to work.
"In a multivariate analysis, relapse after prior high-dose chemotherapy was the most significant risk factor for TRM (hazard ratio [HR], 2.80; 95% CI, 1.16–6.74; P = .02), relapse (HR, 4.14; 95% CI, 2.04–8.38; P < .001), event-free survival (HR, 3.11; 95% CI, 1.77–5.46; P < .001), and overall survival (HR, 2.69; 95% CI, 1.35–5.35; P = .005)."
"In a subgroup of patients with chemosensitivity and no relapse to prior high-dose chemotherapy who underwent transplantation with PBSCs (n = 46), the cumulative risk of nonrelapse mortality at 1 year was only 6% (95% CI, 1%–22%) for related (n = 34) and 8% (95% CI, 1%–54%) for unrelated (n = 12) donors."
http://www.bbmt.org/article/S1083-8791(04)00272-1/fulltext
If you are going to do the allo, it is best to do it early. I know it is a tough decision. Best of luck with it. I am 17 months out from my allo and other than getting Zometa every other month I do not have to take any drugs. I have no therapy related side effects and my QOL is great.
Mark
Prayers are going out your way! I was in my early 40's at diagnosis and I thought that was young. I did an allo as soon as I got to my first CR and it was the best decision I ever made. I did not look at it as auto vs allo - the two really have little in common. An auto is just a high dose of drugs (usually melphalan) and your stem cells are given back to you so you can recover. An allo is giving the patient a donor immune system that has the potential to cure the disease. Risk is a little higher, but the reward is much greater - potential cure! I really looked at it as allo vs maintenance therapy.
The main thing that makes the allo riskier is getting chronic GVHD (graft vs host disease). You should ask your Doctor if he/she uses ATG (antithymocyte globulin). The chance of having extensive chronic GVHD is quite low if ATG is used prior to transplant. It is typically used for 3 days prior to recieving the Donor cells.
IMO to "hold the allo card for another day " is poor advice if you look at the statistics. This study shows how much better allos work if they are done as part of planned early therapy as opposed to in a relapsed setting.
https://ash.confex.com/ash/2011/webprogram/Paper37067.html
Relapse from an auto makes the allo less likely to work.
"In a multivariate analysis, relapse after prior high-dose chemotherapy was the most significant risk factor for TRM (hazard ratio [HR], 2.80; 95% CI, 1.16–6.74; P = .02), relapse (HR, 4.14; 95% CI, 2.04–8.38; P < .001), event-free survival (HR, 3.11; 95% CI, 1.77–5.46; P < .001), and overall survival (HR, 2.69; 95% CI, 1.35–5.35; P = .005)."
"In a subgroup of patients with chemosensitivity and no relapse to prior high-dose chemotherapy who underwent transplantation with PBSCs (n = 46), the cumulative risk of nonrelapse mortality at 1 year was only 6% (95% CI, 1%–22%) for related (n = 34) and 8% (95% CI, 1%–54%) for unrelated (n = 12) donors."
http://www.bbmt.org/article/S1083-8791(04)00272-1/fulltext
If you are going to do the allo, it is best to do it early. I know it is a tough decision. Best of luck with it. I am 17 months out from my allo and other than getting Zometa every other month I do not have to take any drugs. I have no therapy related side effects and my QOL is great.
Mark
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Mark
Re: 22 year old female with Multiple Myeloma
Hi I am so sorry that you were diagnosed at 22! Myself and a few others on here were diagnosed around 30, and that has been a rarity for most of our doctors, but from what I'm seeing more young people are being diagnosed with multiple myeloma so who knows if in the future it will no longer be considered a disease of mature adults.
In my case I was ill for over two years, and was going doctor to doctor and no one would figure it out, kept getting the brush offs Like "stress" "anxiety" "migraines" (many benign conditions when inside I had cancer continuing to spread!) In my 30's I feel better able to cope with this illness. In my 20's I lived a pretty selfish, and careless lifestyle (a lot of partying, didn't eat healthy, didn't sleep much, moved around a lot), but in my 30's I am married, full time job, eat / sleep healthy, and have the means to support myself (like a drug insurance coverage). I don't think I could have coped in my 20's, I admire your strength and beliefs, and it sounds like you have support to get through this!
I am two year remission since my Auto Stem Cell transplant. I chose to skip the maintenance chemo, since I wanted to go back to work. I am generally very sensitive and get all the side effects of drugs so I couldn’t bear to be on thalidomide for the rest of my life. Plus I am a newlywed and we are hoping for a family soon. (life goes on after cancer!) Before my transplant I did 4 months of chemo (Velcade, Dex, Cyclophosphomide). I responded amazing to Velcade. Miracle drug for me, brought my protein down in half the first cycle, and my protein was high at diagnosis about 100 g/l (that would be M-spike of 10 in the states) I had some lesions and bone involvement but it has healed up after two years of Pamidronate (I’m taking a break from that too!)
What I have learned is that there seems to be two thoughts on treatment. One is to be very aggressive right from the start, the other is to hold some stuff back. Try one thing at first, then if you relapse to try something else. Only you and your doctor can decide what is best for you. In my case the Allo was not recommended (even though I was 32) right of the bat. My doctor recommended doing the auto first, and seeing how I respond, if It wasn't good next on the list was an allo. I responded well, and have stayed in remission 2.5 years. I was offered maintenance but we decided to do a break from chemo to let my body heal. Things that should be taken in to consideration are you genetic markers for this disease (which they figure out from the bone marrow biopsy) and which classify your risk. If you are average versus high risk!
I am happy with my choice, and feel 98% back to my old self before I started feeling sick (so 25 year old me!) It's amazing, only by feeling well do I realize how sick I was!
In my case I was ill for over two years, and was going doctor to doctor and no one would figure it out, kept getting the brush offs Like "stress" "anxiety" "migraines" (many benign conditions when inside I had cancer continuing to spread!) In my 30's I feel better able to cope with this illness. In my 20's I lived a pretty selfish, and careless lifestyle (a lot of partying, didn't eat healthy, didn't sleep much, moved around a lot), but in my 30's I am married, full time job, eat / sleep healthy, and have the means to support myself (like a drug insurance coverage). I don't think I could have coped in my 20's, I admire your strength and beliefs, and it sounds like you have support to get through this!
I am two year remission since my Auto Stem Cell transplant. I chose to skip the maintenance chemo, since I wanted to go back to work. I am generally very sensitive and get all the side effects of drugs so I couldn’t bear to be on thalidomide for the rest of my life. Plus I am a newlywed and we are hoping for a family soon. (life goes on after cancer!) Before my transplant I did 4 months of chemo (Velcade, Dex, Cyclophosphomide). I responded amazing to Velcade. Miracle drug for me, brought my protein down in half the first cycle, and my protein was high at diagnosis about 100 g/l (that would be M-spike of 10 in the states) I had some lesions and bone involvement but it has healed up after two years of Pamidronate (I’m taking a break from that too!)
What I have learned is that there seems to be two thoughts on treatment. One is to be very aggressive right from the start, the other is to hold some stuff back. Try one thing at first, then if you relapse to try something else. Only you and your doctor can decide what is best for you. In my case the Allo was not recommended (even though I was 32) right of the bat. My doctor recommended doing the auto first, and seeing how I respond, if It wasn't good next on the list was an allo. I responded well, and have stayed in remission 2.5 years. I was offered maintenance but we decided to do a break from chemo to let my body heal. Things that should be taken in to consideration are you genetic markers for this disease (which they figure out from the bone marrow biopsy) and which classify your risk. If you are average versus high risk!
I am happy with my choice, and feel 98% back to my old self before I started feeling sick (so 25 year old me!) It's amazing, only by feeling well do I realize how sick I was!
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
Re: 22 year old female with Multiple Myeloma
Hi
I'm sorry to hear your diagnosis, I would agree to save the allogenic until later. You might want to read this article - not the one I orignally saw relating to risk v benefits allogenic transplants. But may help you to make more of an informed choice.
http://www.medscape.com/viewarticle/733682
all the best x
I'm sorry to hear your diagnosis, I would agree to save the allogenic until later. You might want to read this article - not the one I orignally saw relating to risk v benefits allogenic transplants. But may help you to make more of an informed choice.
http://www.medscape.com/viewarticle/733682
all the best x
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dbi
Re: 22 year old female with Multiple Myeloma
Dear D'ann,
22! I cant write down what I am really thinking it would be deleted, I thought I was young to be diagnosed at 43. That aside I am very happy with the way my allo has gone (I am in CR) even though I have GVHD. (I wrote a post in the treatment/side effects on autologous SCT vs allogeneic SCT detailing my treatments). My multiple myeloma was refractory to most of the drugs including melphalan (used in an auto) and I never went into remission b4 I had the allo.
GVHD is a scary unknown. Skin, liver and GI tract are the first places to see it. I dont really understand the mechanism of GVHD at the cellular level but I would be asking my doctors/oncologists if environmental factors effect the way a body responds to an allo. For example if the donor hasn't had much such sun exposure and the host has, is the host more likely to experience skin GVHD due to the sun damaged cells being recognised as foreign. The reason I ask this is because of the pattern of skin GVHD I showed. My donor was from Washington, I am from Australia and grew up in a beach town and my skin GVHD was from my T-shirt mark down on my arms, from the bottom of my shorts down my legs and on my face and neck. The top of my arms were clear. If enviromnental factors do have an input then liver and GI GVHD may occur partly because of the damage done when we ingest things that are different from our donor or have a toxic affect on our bodies.
How does this help you. It is possible that your GVHD would be minimal because you and your sister are both young and I am assuming have been exposed to a similiar environment while growing (food, sun etc.). Your main point of difference is that you have multiple myeloma (and thats what hopefully would be targetted). As you get older both of you will become less similiar due to different lifestyles. For example you will have had chemo and your sister wont. What effect will the chemo have on your liver? Would it mean that you would be at a higher risk for liver GVHD? Would it be better to have the allo now instead of waiting? Sorry to give you more questions than answers.
I know the allo saved my life
22! I cant write down what I am really thinking it would be deleted, I thought I was young to be diagnosed at 43. That aside I am very happy with the way my allo has gone (I am in CR) even though I have GVHD. (I wrote a post in the treatment/side effects on autologous SCT vs allogeneic SCT detailing my treatments). My multiple myeloma was refractory to most of the drugs including melphalan (used in an auto) and I never went into remission b4 I had the allo.
GVHD is a scary unknown. Skin, liver and GI tract are the first places to see it. I dont really understand the mechanism of GVHD at the cellular level but I would be asking my doctors/oncologists if environmental factors effect the way a body responds to an allo. For example if the donor hasn't had much such sun exposure and the host has, is the host more likely to experience skin GVHD due to the sun damaged cells being recognised as foreign. The reason I ask this is because of the pattern of skin GVHD I showed. My donor was from Washington, I am from Australia and grew up in a beach town and my skin GVHD was from my T-shirt mark down on my arms, from the bottom of my shorts down my legs and on my face and neck. The top of my arms were clear. If enviromnental factors do have an input then liver and GI GVHD may occur partly because of the damage done when we ingest things that are different from our donor or have a toxic affect on our bodies.
How does this help you. It is possible that your GVHD would be minimal because you and your sister are both young and I am assuming have been exposed to a similiar environment while growing (food, sun etc.). Your main point of difference is that you have multiple myeloma (and thats what hopefully would be targetted). As you get older both of you will become less similiar due to different lifestyles. For example you will have had chemo and your sister wont. What effect will the chemo have on your liver? Would it mean that you would be at a higher risk for liver GVHD? Would it be better to have the allo now instead of waiting? Sorry to give you more questions than answers.
I know the allo saved my life
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LibbyC - Name: LibbyC
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2009
- Age at diagnosis: 43
Re: 22 year old female with Multiple Myeloma
LibbyC,
I am certainly not a Doctor, but I do not think it would make that much difference that you may have grown up in a different environment than your Donor. I know that they use the term "perfect match" when referring to donor cell type, but the only patients that have 100% matched cells are patients that have exact twins. This is not easy to explain. This is probably the best (meaning easiest to understand!) explanation I have seen of it:
"The success or failure of a human leukocyte antigen (HLA)–matched allogeneic stem cell transplantation (SCT) for a patient with leukemia is controlled to a large extent by the powerful alloresponse of the donor T cells against the recipient's minor histocompatibility antigens (mHAgs). These antigens are peptides that are “self” to the recipient but foreign to the donor, nestling in the peptide binding groove of the major histocompatibility (MHC) molecules. The antigenic difference is typically the result of a single nucleotide polymorphisms, giving rise to the inheritance of proteins differing in donor and recipient by a single amino acid—not enough to affect protein function, but occasionally enough to generate powerful T-cell responses to the alternate allele resulting in favorable graft-versus-leukemia (GVL) and deleterious graft-versus-host (GVH) reactions."
http://bloodjournal.hematologylibrary.org/content/115/23/4630.full
Hopefully that helps. Also, allos work best in first CR. If a patient is going to do one, it has the best chance of working and carries less risk if it is done in first CR. I am not to sure where the logic is in the others suggesting a younger patient should wait to do one. Why do it when it has less chance of working?!?!
"Stem-cell transplantation from allogeneic donors may be curative for 10–20% of patients with chemotherapy-resistant, refractory hematologic malignancies, and for up to 80% of patients who are transplanted in remission. Much of the high response and curative potential of allografts is attributed to a ‘graft-versus-tumor’ effect. In patients with multiple myeloma this effect has been well documented.[3–5] In contrast, stem-cell transplantation from autologous or syngeneic donors provides little or no immunologic effect against the myeloma cell. Thus autologous or syngeneic stem-cell transplants are mainly a form of supportive care and require intensive chemotherapy with or without radiation to accomplish eradication of the disease or alternative strategies designed to duplicate or mimic the graft-versus-myeloma effect. Long-term follow-up of recipients of autologous stem-cell transplants indicate a continuing risk of disease recurrence after 5 years, and arguably few if any patients are cured. In contrast allogeneic stem-cell transplants with long-term follow-up appear to result in durable remissions and a lower risk of recurrence after 5 years."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017399/
Mark
I am certainly not a Doctor, but I do not think it would make that much difference that you may have grown up in a different environment than your Donor. I know that they use the term "perfect match" when referring to donor cell type, but the only patients that have 100% matched cells are patients that have exact twins. This is not easy to explain. This is probably the best (meaning easiest to understand!) explanation I have seen of it:
"The success or failure of a human leukocyte antigen (HLA)–matched allogeneic stem cell transplantation (SCT) for a patient with leukemia is controlled to a large extent by the powerful alloresponse of the donor T cells against the recipient's minor histocompatibility antigens (mHAgs). These antigens are peptides that are “self” to the recipient but foreign to the donor, nestling in the peptide binding groove of the major histocompatibility (MHC) molecules. The antigenic difference is typically the result of a single nucleotide polymorphisms, giving rise to the inheritance of proteins differing in donor and recipient by a single amino acid—not enough to affect protein function, but occasionally enough to generate powerful T-cell responses to the alternate allele resulting in favorable graft-versus-leukemia (GVL) and deleterious graft-versus-host (GVH) reactions."
http://bloodjournal.hematologylibrary.org/content/115/23/4630.full
Hopefully that helps. Also, allos work best in first CR. If a patient is going to do one, it has the best chance of working and carries less risk if it is done in first CR. I am not to sure where the logic is in the others suggesting a younger patient should wait to do one. Why do it when it has less chance of working?!?!
"Stem-cell transplantation from allogeneic donors may be curative for 10–20% of patients with chemotherapy-resistant, refractory hematologic malignancies, and for up to 80% of patients who are transplanted in remission. Much of the high response and curative potential of allografts is attributed to a ‘graft-versus-tumor’ effect. In patients with multiple myeloma this effect has been well documented.[3–5] In contrast, stem-cell transplantation from autologous or syngeneic donors provides little or no immunologic effect against the myeloma cell. Thus autologous or syngeneic stem-cell transplants are mainly a form of supportive care and require intensive chemotherapy with or without radiation to accomplish eradication of the disease or alternative strategies designed to duplicate or mimic the graft-versus-myeloma effect. Long-term follow-up of recipients of autologous stem-cell transplants indicate a continuing risk of disease recurrence after 5 years, and arguably few if any patients are cured. In contrast allogeneic stem-cell transplants with long-term follow-up appear to result in durable remissions and a lower risk of recurrence after 5 years."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017399/
Mark
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Mark
Re: 22 year old female with Multiple Myeloma
for me, my doctor said 5 years ago it would have been her recommendation to me, but now the newer drugs are really effective against Myeloma, and she feels more comfortable seeing how the response it. Also, the Allo still has a much higher percent chance being fatal, or causing severe (life long) side effects, so since I am young it is better to try the least fatal stuff first!
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
Re: 22 year old female with Multiple Myeloma
Mark,
Thank you for your detailed reply to my post. Identical twins are the only people who are 100% matched for both MHC and mHAgs. After reading the article on mHAgs I can comprehend how difficult it must be to find a 100% match at both the MHC and mHAgs. I did find it funny that my 100% MUD was a different blood group!!. Your citation on mHAgs is a good explanation and I think I didn't explain what I meant by environmental factors very well.
Many things in the environment can cause mutations and these could be deleterious or simple point mutations that result in an amino acid substitution or only substitute a nucleotide. The longer we live the more mutations we are potentially going to have, the faster your cells divide (if there has been damage or the natural turnover is higher) the possibility of a mutation occuring increases. However I do realise the likelihood of a mutation occuring in an mHAg that would change the amino acid and keep the functional intergrity of the peptide the same would be slim. But the chances of this happening increases with time.
"Also, allos work best in first CR. If a patient is going to do one, it has the best chance of working and carries less risk if it is done in first CR." Do you know why this is?
Libby
Thank you for your detailed reply to my post. Identical twins are the only people who are 100% matched for both MHC and mHAgs. After reading the article on mHAgs I can comprehend how difficult it must be to find a 100% match at both the MHC and mHAgs. I did find it funny that my 100% MUD was a different blood group!!. Your citation on mHAgs is a good explanation and I think I didn't explain what I meant by environmental factors very well.
Many things in the environment can cause mutations and these could be deleterious or simple point mutations that result in an amino acid substitution or only substitute a nucleotide. The longer we live the more mutations we are potentially going to have, the faster your cells divide (if there has been damage or the natural turnover is higher) the possibility of a mutation occuring increases. However I do realise the likelihood of a mutation occuring in an mHAg that would change the amino acid and keep the functional intergrity of the peptide the same would be slim. But the chances of this happening increases with time.
"Also, allos work best in first CR. If a patient is going to do one, it has the best chance of working and carries less risk if it is done in first CR." Do you know why this is?
Libby
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LibbyC - Name: LibbyC
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2009
- Age at diagnosis: 43
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