I have another thread going regarding my stem cell transplant journey, but I have a new question that I thought could warrant its own thread.
When we started harvesting stem cells for my transplant, the goal was to collect 10 million cells for two autologous stem cell transplants (ASCTs). (There is no plan right now for a second transplant; it is a contingency)
In two days we collected 22.55 million cells. I asked the nurse if that meant they would divide the cells into 3 or 4 transplants, and she said she didn't know. Possibly they would just give me one half the cells. To her credit, she said this is a question for the doctor, and I will see her on Thursday.
I only recall reading about the "minimum" necessary number of cells, but I don't recall reading anything that said more cells is better. I will follow whatever recommendation my doctor offers, but I would like to be a bit better informed of the options and issues and this forum seems like a great place to ask.
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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: Infusing more than usual stem cells during ASCT
Hello, Mark.
Great question. I have posted on this in the past (probably before you started regular viewing of the forum). In December 2014, my wife collected 15 million cells in one day (yay). I somehow thought that would be enough for 4 ASCT's. Now of course that was something that I would not wish on anyone, having to do that 4 times, but I was thinking the worst, if it was needed.
Our transplant doctor used about 7.5 million during the transplant, to my surprise, because I thought the number was supposed to be 4 million. He explained that if a larger amount is used, the white blood cells come back somewhat faster, the period of no immune protection is lowered, and the risk of the procedure is somewhat lower.
This is something that may not be followed at different centers, but I think its worth asking the doctor. In our case, it was not a decision point for us at all, we learned about it after the fact, but it was of great interest.
Good luck to you.
Great question. I have posted on this in the past (probably before you started regular viewing of the forum). In December 2014, my wife collected 15 million cells in one day (yay). I somehow thought that would be enough for 4 ASCT's. Now of course that was something that I would not wish on anyone, having to do that 4 times, but I was thinking the worst, if it was needed.
Our transplant doctor used about 7.5 million during the transplant, to my surprise, because I thought the number was supposed to be 4 million. He explained that if a larger amount is used, the white blood cells come back somewhat faster, the period of no immune protection is lowered, and the risk of the procedure is somewhat lower.
This is something that may not be followed at different centers, but I think its worth asking the doctor. In our case, it was not a decision point for us at all, we learned about it after the fact, but it was of great interest.
Good luck to you.
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JPC - Name: JPC
Re: Infusing more than usual stem cells during ASCT
That is very interesting. That may be the case for my center as well. I had just not heard that before.
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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: Infusing more than usual stem cells during ASCT
The following is my personal experience and observations regarding the number of stem cells infused.
My clinic wanted to collect 20-30 million during collection to cover anticipated needs. I was planning a tandem transplant. I collected 18 million and 24 million on consecutive days.
Each transplant I received between 4,5-5 million cells.
I inquired why we didn't use more since it appeared I had plenty. I was told all we really need was 2-2.5, that's why they give 4-5. It made sense if you consider most areas of science have a safety margin built in when possible. I also have learned you can't give a fence two coats of paint at the same time.
I believe a transplant's greatest exposure is during the neutropenic period. No matter how many stem cells you receive, the melphalan is going to take your WBC to 0.02 or 0.03 levels before recovering. And that's going to happen because you interrupted / killed the WBC production.
Everybody may not have blood recovery like I did, so the following may not apply to anybody but me. When I started to recover / engraft / produce WBC, the counts more than doubled day to day. So I assume after bottoming out, the most I could benefit from double infused stem cells is to possibly have double the number of WBC on the recovery side. Since I was doubling my WBC daily, it might have bought a day of less exposure if I had a double dose infusion.
I was neutropenic (WBC<2) for 9 days starting day 4, or something like that. So one day less neutropenic is an improvement to exposure to neutropenic problems. I wouldn't call that trivial.
Now you might have to weigh any negatives and how valuable those little babies are in the bank. Time outs can't help you any when the game clock expires.
I guess there is an optimal number for each patient, for their specific circumstances and that's why we pay them the big bucks.
Do you want to venture to guess if it's dex day?
My clinic wanted to collect 20-30 million during collection to cover anticipated needs. I was planning a tandem transplant. I collected 18 million and 24 million on consecutive days.
Each transplant I received between 4,5-5 million cells.
I inquired why we didn't use more since it appeared I had plenty. I was told all we really need was 2-2.5, that's why they give 4-5. It made sense if you consider most areas of science have a safety margin built in when possible. I also have learned you can't give a fence two coats of paint at the same time.
I believe a transplant's greatest exposure is during the neutropenic period. No matter how many stem cells you receive, the melphalan is going to take your WBC to 0.02 or 0.03 levels before recovering. And that's going to happen because you interrupted / killed the WBC production.
Everybody may not have blood recovery like I did, so the following may not apply to anybody but me. When I started to recover / engraft / produce WBC, the counts more than doubled day to day. So I assume after bottoming out, the most I could benefit from double infused stem cells is to possibly have double the number of WBC on the recovery side. Since I was doubling my WBC daily, it might have bought a day of less exposure if I had a double dose infusion.
I was neutropenic (WBC<2) for 9 days starting day 4, or something like that. So one day less neutropenic is an improvement to exposure to neutropenic problems. I wouldn't call that trivial.
Now you might have to weigh any negatives and how valuable those little babies are in the bank. Time outs can't help you any when the game clock expires.
I guess there is an optimal number for each patient, for their specific circumstances and that's why we pay them the big bucks.
Do you want to venture to guess if it's dex day?
Last edited by blueblood on Thu Jul 14, 2016 11:57 am, edited 1 time in total.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Infusing more than usual stem cells during ASCT
Thank you all for the responses. Since posting I learned something interesting. The lab made a mistake.
My 2nd day count was 7.4 million, not the previously reported 16.65. Now I'm more curious about how a 10 million count error occurred than I am how the cells will be used.
My 2nd day count was 7.4 million, not the previously reported 16.65. Now I'm more curious about how a 10 million count error occurred than I am how the cells will be used.
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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: Infusing more than usual stem cells during ASCT
I asked the same question during my stem cell transplant recovery - is more better? The answer I was given is that there is an upper limit on the number of stem cells they want to give you. If you go above that limit, problems can result. Unfortunately, I don't recall what the upper limit was.
Here is one abstract that talks about an upper limit,
Jillella, A.P., and Ustun, C., "What Is the Optimum Number of CD34+ Peripheral Blood Stem Cells for an Autologous Transplant?," Stem Cells And Development, 2004 (abstract)
It's a bit old now (2004) and mentions one study showing better results with >15M stem cells being infused. But it also talks about "a few" studies that found high levels of stem cells led to engraftment syndrome, fever, and prolonged hospital stays.
As a side comment, this question became sort of important during my transplant recovery. My stem cells took an exceptionally long time to engraft, probably due to an E. coli infection and sepsis that came on around Day +8. When we were around Day +21 and there was still no sign of engraftment, doctors started talking about possibly giving me a second "dose" of my stem cells. Fortunately, the stem cells did begin engrafting around Day +24, the limit the doctors had set before they would do a bone marrow biopsy on me to see if anything was happening in there (and, if not, give me more stem cells). I was definitely not in the mood for a bone marrow biopsy at that point.
Mike
Here is one abstract that talks about an upper limit,
Jillella, A.P., and Ustun, C., "What Is the Optimum Number of CD34+ Peripheral Blood Stem Cells for an Autologous Transplant?," Stem Cells And Development, 2004 (abstract)
It's a bit old now (2004) and mentions one study showing better results with >15M stem cells being infused. But it also talks about "a few" studies that found high levels of stem cells led to engraftment syndrome, fever, and prolonged hospital stays.
As a side comment, this question became sort of important during my transplant recovery. My stem cells took an exceptionally long time to engraft, probably due to an E. coli infection and sepsis that came on around Day +8. When we were around Day +21 and there was still no sign of engraftment, doctors started talking about possibly giving me a second "dose" of my stem cells. Fortunately, the stem cells did begin engrafting around Day +24, the limit the doctors had set before they would do a bone marrow biopsy on me to see if anything was happening in there (and, if not, give me more stem cells). I was definitely not in the mood for a bone marrow biopsy at that point.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
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