Am I correct in understanding that in the autologous stem cell transplant process, harvested stem cells are returned to the donor as extracted, myeloma and all?
If so, why are anti-myeloma agents not applied to the extracted cells in an attempt to reduce or eliminate the return of diseased cells?
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Re: Autologous stem cell transplants & myeloma cells
I wondered the same thing and looked into it. It turns out that it has been tried but did not improve overall survival:
Stewart, AK, et al, "Purging of Autologous Peripheral-Blood Stem Cells Using CD34 Selection Does Not Improve Overall or Progression-Free Survival After High-Dose Chemotherapy for Multiple Myeloma: Results of a Multicenter Randomized Controlled Trial," Journal of Clinical Oncology, September 2001 (abstract)
This tends to suggest that the primary cause of relapse is multiple myeloma cells in the bone marrow that survive high dose chemo, rather than multiple myeloma cells derived from the reinfused stem cells.
Stewart, AK, et al, "Purging of Autologous Peripheral-Blood Stem Cells Using CD34 Selection Does Not Improve Overall or Progression-Free Survival After High-Dose Chemotherapy for Multiple Myeloma: Results of a Multicenter Randomized Controlled Trial," Journal of Clinical Oncology, September 2001 (abstract)
This tends to suggest that the primary cause of relapse is multiple myeloma cells in the bone marrow that survive high dose chemo, rather than multiple myeloma cells derived from the reinfused stem cells.
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Davidg - Name: David
- When were you/they diagnosed?: Feb 2015 - AL Amyloidosis
- Age at diagnosis: 53
Re: Autologous stem cell transplants & myeloma cells
It probably won't surprise either of you to hear that this subject has come up a number of times in the forum. I've found at least three threads on the subject, but I suspect there are others.
The three threads I found were these:
"Treating collected stem cells to kill myeloma cells" (started Nov 13, 2013)
""Contaminated" stem cells vs. residual disease in the body" (started Oct 8, 2012)
"Myeloma cells in marrow at harvest for SCT" (March 8, 2015)
There are posts in each of the threads by several knowledgeable forum regulars, including Multibilly, Mark, JimNY, and Dr. Voorhees. The general thrust of the postings is what David wrote, which is that purging the stem cell graft of myeloma cells has been tried in the past (now somewhat distant past), and wasn't found to make much of a difference.
(Maybe someone can pull a couple key excerpts from the postings in those threads as highlights to include in this thread?)
I think it's worth adding that the Beacon recently reported on a French study with results that seem relevant to this discussion. Here is an excerpt of the Beacon article:
"The researchers found that myeloma cells were detectable in 23 percent of the patient's stem cell samples at the time of collection, and 18 percent of the samples tested at the time of reinfusion ...
"Progression-free survival was longer for patients who did not have myeloma cells in their stem cell infusions compared to those who did (not yet reached versus a median of 16 months, respectively). The authors of the study note, however, that their data on this point needs to be interpreted cautiously, because patient characteristics and initial treatment varied noticeably across the study participants."
Source:
"Myeloma Morning: Myeloma Cells In Stem Cell Reinfusions, And Cytoxan And Mobilization," The Myeloma Beacon, April 7, 2016.
The three threads I found were these:
"Treating collected stem cells to kill myeloma cells" (started Nov 13, 2013)
""Contaminated" stem cells vs. residual disease in the body" (started Oct 8, 2012)
"Myeloma cells in marrow at harvest for SCT" (March 8, 2015)
There are posts in each of the threads by several knowledgeable forum regulars, including Multibilly, Mark, JimNY, and Dr. Voorhees. The general thrust of the postings is what David wrote, which is that purging the stem cell graft of myeloma cells has been tried in the past (now somewhat distant past), and wasn't found to make much of a difference.
(Maybe someone can pull a couple key excerpts from the postings in those threads as highlights to include in this thread?)
I think it's worth adding that the Beacon recently reported on a French study with results that seem relevant to this discussion. Here is an excerpt of the Beacon article:
"The researchers found that myeloma cells were detectable in 23 percent of the patient's stem cell samples at the time of collection, and 18 percent of the samples tested at the time of reinfusion ...
"Progression-free survival was longer for patients who did not have myeloma cells in their stem cell infusions compared to those who did (not yet reached versus a median of 16 months, respectively). The authors of the study note, however, that their data on this point needs to be interpreted cautiously, because patient characteristics and initial treatment varied noticeably across the study participants."
Source:
"Myeloma Morning: Myeloma Cells In Stem Cell Reinfusions, And Cytoxan And Mobilization," The Myeloma Beacon, April 7, 2016.
Re: Autologous stem cell transplants & myeloma cells
Many thanks Terry. I recall reading the French study. If I remember rightly, the multiple myeloma cell quantities in the reinfused positive cases were very high, which presumably reflected a high underlying bone marrow burden. So there may be cases of correlation rather than causation.
Intuitively one does feel that it ought to make a difference, but of course the underlying biology of relapse is both complicated and not well understood. So it is probably not as simple as trying not to reinfuse "bad" cells.
Intuitively one does feel that it ought to make a difference, but of course the underlying biology of relapse is both complicated and not well understood. So it is probably not as simple as trying not to reinfuse "bad" cells.
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Davidg - Name: David
- When were you/they diagnosed?: Feb 2015 - AL Amyloidosis
- Age at diagnosis: 53
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