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Deletion 17P (TP53)
My husband was diagnosed in Aug 2011. He had a BIG plasmacytoma in the spine had radiation for that. He has had several bone marrow biopsies, but noticed the last one in March had the Deletion 17P (TP53) as well as 1-2 extra copies of IGH, FGFR3 and CCDN1. It was noted that this deletion is to be an unfavorable prognostic indicator in myeloma. The other bone marrow biopsies didn't show this. Does it come on if the myeloma becomes more aggresive? The doctor didn't mention it. His Plasma cells went from 46% to 5%, the doctor said he was doing well. Now I'm really confused from what I have read about the Deletion 17p. Can anyone explain this? Thank you.
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bohannon
Re: Deletion 17P (TP53)
TP53 is a gene mutation. It does have something to do with the risk stratification; but it has nothing to do with how well the patient is. Patients with TP53 trait can also be in remission. Unfortunately, research have shown that TP53 patiens have poorer prognosis, such as a more aggressive disease and earlier relapse. My Dad also has this trait, but he is still in remission.
TP53 is a mutation, which means that it may not be there in the past, but it is here today. Also remember that myeloma is a very patchy disease (hence multiple myeloma), so it doesn't necessarily appear on all of those biopsies.
Don't worry about it that much, and please try not to be discouraged. Now, with the new risk stratification, some TP53 patients have falleninto an intermediate risk. Prognosis is poorer, but overall prognosis has increased since the introduction of Velcade (especially for TP53 trait).
TP53 is a mutation, which means that it may not be there in the past, but it is here today. Also remember that myeloma is a very patchy disease (hence multiple myeloma), so it doesn't necessarily appear on all of those biopsies.
Don't worry about it that much, and please try not to be discouraged. Now, with the new risk stratification, some TP53 patients have falleninto an intermediate risk. Prognosis is poorer, but overall prognosis has increased since the introduction of Velcade (especially for TP53 trait).
Re: Deletion 17P (TP53)
Dear bohannon,
Is the disease currenly under control? Why was the marrow done in March and what level of disease did it show?
Pete
Is the disease currenly under control? Why was the marrow done in March and what level of disease did it show?
Pete
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Deletion 17P (TP53)
Thank you for your questions, Dr Pete.
My husband's multiple myeloma, M Spike has been going up the last months from his lowest at 0.5 to 0.6 to 0.9 to 1. to 1.1 last month. Other marker Beta 2 was up and down, now in the normal range last month. He has been off the Revlimid for over 2 months due to chest pain and side effects. He was also having extreme diarrhea and pain in that are. I don't know if it's under control, we have only seen his oncologist 2 times out of the last 5 months, seen the nurse practitioner 3 times. No one says anything about it being under control.
He was diagnosed Aug 2011 with stage 1, a large plasmacytoma on the spine, treated with radiation. He has had 3 bone marrow biopsies since 2011. The last one was routine in March? Along with a PET scan. Velcade worked for about 6 months, then the side effects from that came. They started it subcutaneously and hardly any side effects, unfortunately it failed to work and all markers went up.
He also had prostate cancer in 2000 treated with eternal beam radiation and high dose temporary bracytherapy with no recurrence. His PSA has climbed from a low of .01 and about 3 years ago started doubling and now is at 1.9 as of last month. NO ONE knows what to think or do about that.
He has blood work tomorrow and HOPEFULLY will see the doctor next week for his appointment. Any input will be appreciated.
Thank You
My husband's multiple myeloma, M Spike has been going up the last months from his lowest at 0.5 to 0.6 to 0.9 to 1. to 1.1 last month. Other marker Beta 2 was up and down, now in the normal range last month. He has been off the Revlimid for over 2 months due to chest pain and side effects. He was also having extreme diarrhea and pain in that are. I don't know if it's under control, we have only seen his oncologist 2 times out of the last 5 months, seen the nurse practitioner 3 times. No one says anything about it being under control.
He was diagnosed Aug 2011 with stage 1, a large plasmacytoma on the spine, treated with radiation. He has had 3 bone marrow biopsies since 2011. The last one was routine in March? Along with a PET scan. Velcade worked for about 6 months, then the side effects from that came. They started it subcutaneously and hardly any side effects, unfortunately it failed to work and all markers went up.
He also had prostate cancer in 2000 treated with eternal beam radiation and high dose temporary bracytherapy with no recurrence. His PSA has climbed from a low of .01 and about 3 years ago started doubling and now is at 1.9 as of last month. NO ONE knows what to think or do about that.
He has blood work tomorrow and HOPEFULLY will see the doctor next week for his appointment. Any input will be appreciated.
Thank You
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Bohannon
Re: Deletion 17P (TP53)
Hello. My husband was diagnosed with multiple myeloma last October. He went a 4 month treatment with Velcade, but he did not responded and the plasmacytoma in his hip got much worst. A FISH confirmed the presence of deletion 17 (TP53). He had 10 sessions of radiation therapy and will start a new therapy tomorrow with Velcade, Revlimid and dexamethasone. He is scheduled for a bone marrow heterologous transplant immediately after the chemotherapy.
Is there a way to fix the deletion in this gene with gene replacement therapy? I know that this type of therapy is experimental, but does anybody know if it would make sense to think about it?
Does anybody know about clinical trials with Advexin [INGN 201] in the US?
I found an article very interesting about this subject. I am not a doctor, but I think I can understand the conclusions and the non-technical sections of it.
http://cshperspectives.cshlp.org/content/2/9/a001222.full.pdf
Is there a way to fix the deletion in this gene with gene replacement therapy? I know that this type of therapy is experimental, but does anybody know if it would make sense to think about it?
Does anybody know about clinical trials with Advexin [INGN 201] in the US?
I found an article very interesting about this subject. I am not a doctor, but I think I can understand the conclusions and the non-technical sections of it.
http://cshperspectives.cshlp.org/content/2/9/a001222.full.pdf
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sdeco - Name: Silvia
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: 6 months ago
- Age at diagnosis: 62
Re: Deletion 17P (TP53)
Silvia,
The kind of gene therapy your are describing is still quite some ways off. The kind of gene therapy they are experimenting with in multiple myeloma trials is using gene therapy to modify one's T-Cells to train them to go after the cancerous myeloma cells. So, here you are modifying a part of your immune system to go after the cancer ... but not actually going in and "fixing" a chromosomal mutation on the plasma cell itself.
VRd is a standard course of treatment recommended by the Mayo for those with 17p deletions. I hope you see good results.
The kind of gene therapy your are describing is still quite some ways off. The kind of gene therapy they are experimenting with in multiple myeloma trials is using gene therapy to modify one's T-Cells to train them to go after the cancerous myeloma cells. So, here you are modifying a part of your immune system to go after the cancer ... but not actually going in and "fixing" a chromosomal mutation on the plasma cell itself.
VRd is a standard course of treatment recommended by the Mayo for those with 17p deletions. I hope you see good results.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Deletion 17P (TP53)
Silvia,
There do not seem to be any ongoing trials involving Advexin (INGN 201) at this time. All have been completed or terminated -- at least according to the rather comprehensive (and international) database at clinicaltrials.gov. You can view a list of the completed / terminated trials here:
http://clinicaltrials.gov/ct2/results?term=advexin
There do not seem to be any ongoing trials involving Advexin (INGN 201) at this time. All have been completed or terminated -- at least according to the rather comprehensive (and international) database at clinicaltrials.gov. You can view a list of the completed / terminated trials here:
http://clinicaltrials.gov/ct2/results?term=advexin
Re: Deletion 17P (TP53)
Thanks for all the answers. He will start a new chemotherapy tomorrow with Velcade + Revlimid + dexamethasone. I am keeping my fingers crossed and will keep you posted.
Silvia
Silvia
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sdeco - Name: Silvia
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: 6 months ago
- Age at diagnosis: 62
Re: Deletion 17P (TP53)
In his current situation, Velcade, Revlimid, and dexamethasone are a very good combination and he should do quite well. This should be followed up with consolidation with a transplant and likely maintenance therapy.
Unfortunately, we are not to the point of replacing the genes that, at least in part, contribute to myeloma, to the best of my knowledge. Moreover, even the studies with INGN 201 had questionable efficacy and remain very difficult to give on a broad scale.
We wish you the best.
Unfortunately, we are not to the point of replacing the genes that, at least in part, contribute to myeloma, to the best of my knowledge. Moreover, even the studies with INGN 201 had questionable efficacy and remain very difficult to give on a broad scale.
We wish you the best.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Deletion 17P (TP53)
My FISH results indicated deletion of TP53.
Nowhere was I told that I have deletion 17P. So what does this mean when the both of them occur together in your comments? Is it a synonym for the same thing? Or are you saying you have both of them? Or is 17P the same thing as TP53?
Is so, why the distinction?
Not sure if I should post this as a separate question, but I'll start here.
Nowhere was I told that I have deletion 17P. So what does this mean when the both of them occur together in your comments? Is it a synonym for the same thing? Or are you saying you have both of them? Or is 17P the same thing as TP53?
Is so, why the distinction?
Not sure if I should post this as a separate question, but I'll start here.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
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