I a 70 year old male diagnosed in 2009 with Stage II multiple myeloma, IgG Lambda. Asymptomatic despite neutropenia and anemia. My oncologist felt it was a good idea to collect stem cells to provide option to go transplant route. Performed one cycle of induction with novel combo of Velcade, dexamethasone, and thalidomide (VDT) and four drug chemo combination including cyclophosphamide and etoposide followed by GCSF when WBC's recovered, and finally Mozobil.
No stem cells after two days of apheresis. After time (six weeks), tried again with single dose of etoposide followed by GCSF for 13 days. Insufficient peripheral stem cells to even try apheresis or Mozobil.
Does anyone have any suggestions, or should we simply give up on trying to harvest stem cells?
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Re: Difficulty harvesting stem cells
Hi Gary,
Sorry to hear about the mobilization problems. Sometimes a person just does not mobilize stem cells very well.
However, a few issues that you can discuss with your doctors: Had you received any treatment before the VDT followed by mobilization? If so, sometimes therapy, especially prolonged lenalidomide [Revlimid] (>4 cycles), can diminish the stem cell yield. If this was your first therapy, there are times when you need more therapy to decrease the amount of plasma cells in the bone marrow which can interfere with normal bone marrow function.
Another issue is to be sure that there is no evidence of myelodysplastic syndrome in the bone marrow, but I am sure that your doctors thought of that. Did you actually go on the apheresis machine with the second mobilization, or was your CD34 count so low that your doctors did not start the collection? You may want to check as to how low the stem cell counts were from the two collections, as there are usually some cells, even if not enough.
I am surprised that the plerixafor (Mozobil) did not work. Sometime it is necessary to use multiple doses (up to four or so).
Finally, if the marrow is pretty clean, a bone marrow harvest can be done for stem cell collection. So, the bottom line is to speak with your doctors about options. If you cannot collect stem cells, there are plenty of non-transplant options for treating the multiple myeloma.
Sorry to hear about the mobilization problems. Sometimes a person just does not mobilize stem cells very well.
However, a few issues that you can discuss with your doctors: Had you received any treatment before the VDT followed by mobilization? If so, sometimes therapy, especially prolonged lenalidomide [Revlimid] (>4 cycles), can diminish the stem cell yield. If this was your first therapy, there are times when you need more therapy to decrease the amount of plasma cells in the bone marrow which can interfere with normal bone marrow function.
Another issue is to be sure that there is no evidence of myelodysplastic syndrome in the bone marrow, but I am sure that your doctors thought of that. Did you actually go on the apheresis machine with the second mobilization, or was your CD34 count so low that your doctors did not start the collection? You may want to check as to how low the stem cell counts were from the two collections, as there are usually some cells, even if not enough.
I am surprised that the plerixafor (Mozobil) did not work. Sometime it is necessary to use multiple doses (up to four or so).
Finally, if the marrow is pretty clean, a bone marrow harvest can be done for stem cell collection. So, the bottom line is to speak with your doctors about options. If you cannot collect stem cells, there are plenty of non-transplant options for treating the multiple myeloma.
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Dr. Philip McCarthy - Name: Philip McCarthy Jr., M.D.
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