My treatment is moving forward, and I will be going from my initial induction therapy with Kyprolis, Pomalyst and dex following cycle 5 to the transplant team in June. I spoke to the transplant nurse coordinator last week about the schedule and that is when I got some information I hadn't been prepared for and now I have questions about.
I will be checking in with the transplant team June 21 and begin a couple weeks of testing, and education, with the real fun beginning the first of July. That said, the stem cell transplant won't actually be until the first of August and that is where I was thrown off.
My last blood test has an M-spike of 0.6 g/dL from 0.7 the month before. I knew that meant I was at a plateau and I don't expect much more of a drop with the last cycle. The nurse indicated the transplant team will want to do a round of "conditioning" chemo (not sure what drug or dose as I don't have those details yet) July 8-10, watch my numbers for a week or so, and then give my body a break at the end of July. The harvesting and high dose chemo and transplant would then be around August 8.
I was not prepared for the conversation about the conditioning therapy or the time it adds to the process. I've looked through the forums and didn't find a lot of discussion on this process. I'm hoping I can get information from those of you with more knowledge or even better those of you who have had this as part of your stem cell transplant experience.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
Re: Conditioning chemo before auto transplant?
Hello Mark:
The conditioning for the stem cells could potentially be Neupogen, to stimulate the production of stem cells, and also Mozobil, the stimulate their release into the blood stream.
The immunodulatory agents ("imids" – thalidomide, Revlimid, and Pomalyst) suppress stem cell production, however, usually not that much for no more that about 4 or 5 rounds. For more rounds of immunomodulatory agent than that, stem cell collection does get to be a challenge.
Neupogen and Mozobil I do not think would be called "chemo". I understand neither of them has any anti-myeloma effect. Historically, one of the chemo agents has been used in stem cell collection. That would be Cytoxan (cyclophosphamide), and interestingly, in addition to hitting the myeloma, it has an effect of stimulating stem cell production. The way Cytoxan is used for stem cell mobilization is not rock solid consistent from center to center. In my wife's case, she did not reach zero pre-ASCT, but had a decent very good partial response (VGPR) with an M-spike of a little under 0.4 g/dL (she had started at 7), and she got under the wire with a low plasma cell percentage. At the center where we went (MSKCC in NY), the Cytoxan would be used if the % plasma cells were 10% or higher.
I think the general idea is to simultaneously try and get a little better response going into the ASCT, and to stimulate the production of the stem cells.
Hope this helps.
The conditioning for the stem cells could potentially be Neupogen, to stimulate the production of stem cells, and also Mozobil, the stimulate their release into the blood stream.
The immunodulatory agents ("imids" – thalidomide, Revlimid, and Pomalyst) suppress stem cell production, however, usually not that much for no more that about 4 or 5 rounds. For more rounds of immunomodulatory agent than that, stem cell collection does get to be a challenge.
Neupogen and Mozobil I do not think would be called "chemo". I understand neither of them has any anti-myeloma effect. Historically, one of the chemo agents has been used in stem cell collection. That would be Cytoxan (cyclophosphamide), and interestingly, in addition to hitting the myeloma, it has an effect of stimulating stem cell production. The way Cytoxan is used for stem cell mobilization is not rock solid consistent from center to center. In my wife's case, she did not reach zero pre-ASCT, but had a decent very good partial response (VGPR) with an M-spike of a little under 0.4 g/dL (she had started at 7), and she got under the wire with a low plasma cell percentage. At the center where we went (MSKCC in NY), the Cytoxan would be used if the % plasma cells were 10% or higher.
I think the general idea is to simultaneously try and get a little better response going into the ASCT, and to stimulate the production of the stem cells.
Hope this helps.
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JPC - Name: JPC
Re: Conditioning chemo before auto transplant?
Thank you, JPC. I know the conversation included both the idea of stimulating the stem cells AND getting a bit better response. I don't know if there is a "magic number" that I might still reach after the final cycle of induction or after the bone marrow biopsy results.
Your explanation does help me understand what we discussed a bit better.
Your explanation does help me understand what we discussed a bit better.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
Re: Conditioning chemo before auto transplant?
Hi Mark,
The 'conditioning' regimen is something that most transplant patients have to do. (Went through it myself last September.) The Neupogen shots do have some not-nice side effects, but you only have to deal with it for about 2 weeks, and I didn't really have much side effects until the second week. The 'harvest' itself wasn't too bad.
Good luck with the transplant. It's a long haul, but great once you're on the other side of it if things have gone well.
RT
The 'conditioning' regimen is something that most transplant patients have to do. (Went through it myself last September.) The Neupogen shots do have some not-nice side effects, but you only have to deal with it for about 2 weeks, and I didn't really have much side effects until the second week. The 'harvest' itself wasn't too bad.
Good luck with the transplant. It's a long haul, but great once you're on the other side of it if things have gone well.
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: Conditioning chemo before auto transplant?
I thought I would cap this conversation in case someone searches it in the future.
In my situation, the transplant doctors originally planned on a treatment of "dual purpose" chemo before introducing growth factor drugs (Neupogen) to both mobilize the stem cells and bring my cancer numbers down. This IS different then the more standard practice of just mobilizing the cells before harvesting. Not only does it introduce an extra round of chemo, it adds a few weeks to the process to allow your body and blood to "recover" a bit before the transplant process.
After all of the testing that occurs before transplant, my doctors decided I did not need this extra chemo treatment, and I will be going straight to mobilization with the growth factor drugs followed by harvesting and transplant.
In my situation, the transplant doctors originally planned on a treatment of "dual purpose" chemo before introducing growth factor drugs (Neupogen) to both mobilize the stem cells and bring my cancer numbers down. This IS different then the more standard practice of just mobilizing the cells before harvesting. Not only does it introduce an extra round of chemo, it adds a few weeks to the process to allow your body and blood to "recover" a bit before the transplant process.
After all of the testing that occurs before transplant, my doctors decided I did not need this extra chemo treatment, and I will be going straight to mobilization with the growth factor drugs followed by harvesting and transplant.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
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