[Steve Mohr]

Re: Should I do an early stem cell transplant?

by Steve Mohr on Fri Jul 25, 2014 4:07 pm

Ellen,

I just had a stem cell transplant in mid June - was discharged from the hospital 1 month ago yesterday. I started chemo in October and the original plan was to have the transplant in December. December was a horrible time for me in regards to my job, my wife's job, and more importantly, family commitments. My doctor saw no possible harm in waiting till June, so that is what we did.

My point is that is there are sometimes other factors other than medical reasons for scheduling a transplant. Your point about having a transplant at 59 rather than 65 is one that weighed heavily in my decision. I am very close to your age, 58, and in very good health apart from having this disease. I felt more comfortable having the transplant during a time when I was experiencing good health than waiting for a time in the future not knowing what my health might be.

Good luck in your decision!
Steve

[vicstir]

Re: Should I do an early stem cell transplant?

by vicstir on Fri Jul 25, 2014 5:04 pm

Hello Ellen,

If you are putting off a stem cell transplant due to fear of how you will feel/cope with it, then don't let that be your decider. It's natural to fear the unknown..

Having had one myself in May, I won't lie. It's not pleasant. But you do get over it.
Alternatively you could flip a coin. Let fate decide ...

I know I'm helpful. Lol

Vicki

[Dr. Edward Libby]

Re: Should I do an early stem cell transplant?

by Dr. Edward Libby on Sun Jul 27, 2014 3:21 pm

Hello again Ellen,

The 1q gain detected in your cytogenetic analysis is considered to be an adverse risk factor for newly diagnosed patients with multiple myeloma. The full impact of this change is not fully understood as of yet. In particular, whether an early autologous stem cell transplant (ASCT) will change your prognosis is not known. Studies comparing early versus late ASCT in patients with 1q gain do not exist.

We do know that patients with t(4;14) seem to do better with the use of bortezomib (Velcade)-based induction regimens followed by ASCT and then maintenance. For patients with TP53 or del17p, it is not clear that ASCT is beneficial, although some trials have suggested that aggressive therapy with ASCT will improve outcomes. Deletions of 1p are also associated with a poor prognosis.

Much more research is needed in these genetic abnormalities. We currently do not have any chemotherapy or drug that specifically targets or clearly provides improved outcomes in patients with 1q or 1p abnormalities.

Having said all of this, I think that most myeloma experts would recommend upfront (early ) stem cell transplantation for you because of the adverse genetics in your multiple myeloma cells. In a major study published in 2012 that reported on the outcomes of 520 patients after ASCT, patients with 1q gains did significantly better (lived longer) than patients with either t(4;14) or del(17p).

Two other important considerations for early versus late transplantation would be your ISS stage at diagnosis and whether or not you can achieve a complete remission with induction chemotherapy.

I wish you all my best with this difficult decision. My personal recommendation would be an early ASCT.

[Ellen Harris]

Re: Should I do an early stem cell transplant?

by Ellen Harris on Mon Jul 28, 2014 7:12 am

Thank you very much for your insight Dr. Libby. I think the issue of waiting to transplant has been raised by my doctors because I had a strong response to RVD. I am fortunate indeed to have choices. Interestingly, it is my general oncologist who seems to be in the early transplant camp. It is the two myeloma specialists who raised the issue of waiting to transplant with the caveat that I would have to be in remission with MRD negative status.

My light chains were 28 on my last test, so i am close to normal, but I have not had another bone marrow biopsy since diagnosis. So it remains to be seen what that will show.

I should also mention that my father had multiple myeloma. He was diagnosed at 47 and succumbed at 50 in 1969. So, I think the role of genetics in my case is significant. Thank you again for your recommendations Dr. Libby.