I'm finishing up my 4th round of induction therapy. My doctor has suggested that I do an autologous stem cell transplant, but I responded so well to induction therapy that I would rather wait on the transplant.
However, I do have the option to collect stem cells now and store them for the future if I want to have a transplant at some point.
Is there an advantage to harvesting stem cells after induction therapy if no immediate transplant is planned.
Or is it better to wait to harvest the stem cells?
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Kebo - Name: Kebo
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2008
- Age at diagnosis: 51
Re: Harvest stem cells now or later?
Hi Kebo
I just had my stem cells harvested this week. I was informed the sooner you can harvest your cells, the better. This is due to the more future treatments you may need will make it harder for them to get your stem cells due to the chemo.
Having said that, I didn't have a lot of chemo for my induction, and they had trouble getting my stem cells, but I got there in the end.
I'm new to myeloma, but I'm pretty sure this is the reason.
Good luck,
Dean
I just had my stem cells harvested this week. I was informed the sooner you can harvest your cells, the better. This is due to the more future treatments you may need will make it harder for them to get your stem cells due to the chemo.
Having said that, I didn't have a lot of chemo for my induction, and they had trouble getting my stem cells, but I got there in the end.
I'm new to myeloma, but I'm pretty sure this is the reason.
Good luck,
Dean
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Dean UK - Name: Dean
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 41
Re: Harvest stem cells now or later?
Hi Kebo,
Glad to hear that you've had such a good response to your induction therapy.
Before you spend a lot of time thinking about the question you asked, you may want to make sure that your insurance will cover the cost of harvesting and then storing your stem cells until you want to use them for a transplant. Either your insurance or your treatment center is going to have to cover the cost of harvesting and store the cells.
As Dean says, I think there is a preference for harvesting after initial induction therapy, rather than later, because of the impact treatments can have on the body's ability to mobilize enough stem cells for a successful harvest.
Dr. Shain mentions in this forum post that "early collection and then storage is preferred", but also notes that "delayed collection should not be a large issue".
Glad to hear that you've had such a good response to your induction therapy.
Before you spend a lot of time thinking about the question you asked, you may want to make sure that your insurance will cover the cost of harvesting and then storing your stem cells until you want to use them for a transplant. Either your insurance or your treatment center is going to have to cover the cost of harvesting and store the cells.
As Dean says, I think there is a preference for harvesting after initial induction therapy, rather than later, because of the impact treatments can have on the body's ability to mobilize enough stem cells for a successful harvest.
Dr. Shain mentions in this forum post that "early collection and then storage is preferred", but also notes that "delayed collection should not be a large issue".
Re: Harvest stem cells now or later?
Hi Kebo,
Congratulations on your good response to your induction therapy.
I am a similar situation as you in that my induction theory is going really well. I’m just finishing third round of what was initially planned as a nine round treatment. Soon I’ll have to make a choice about having a stem cell transplant. That has put me in an investigative mood regarding stem cell transplants.
One thing that I discovered is that cryogenically stored stem cells have a shelf life. My local transplant centre says that they keep their stored stem cells for seven years, at which point the cells are either destroyed or used for research purposes. Although seven years is a long time in the context of myeloma, I still think it is worth noting that cells deteriorate when in long-term storage.
If I were thinking to delay my stem cell transplant by only a year or two, I would definitely go ahead with an early harvest. That way that unpleasantness would be out of the way, and I would have the confidence that my stored stem cells were still of good quality. Besides, as Terry and Dean have pointed out, an early harvest leads to a good yield.
Good luck with your choice.
Joe
Congratulations on your good response to your induction therapy.
I am a similar situation as you in that my induction theory is going really well. I’m just finishing third round of what was initially planned as a nine round treatment. Soon I’ll have to make a choice about having a stem cell transplant. That has put me in an investigative mood regarding stem cell transplants.
One thing that I discovered is that cryogenically stored stem cells have a shelf life. My local transplant centre says that they keep their stored stem cells for seven years, at which point the cells are either destroyed or used for research purposes. Although seven years is a long time in the context of myeloma, I still think it is worth noting that cells deteriorate when in long-term storage.
If I were thinking to delay my stem cell transplant by only a year or two, I would definitely go ahead with an early harvest. That way that unpleasantness would be out of the way, and I would have the confidence that my stored stem cells were still of good quality. Besides, as Terry and Dean have pointed out, an early harvest leads to a good yield.
Good luck with your choice.
Joe
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Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: Harvest stem cells now or later?
Hello Kebo,
I was diagnosed in January 2014. Had treatments for that year leading up to a complete response around December. During that response, I had my cells harvested the first part of 2015. The stem cell harvest was not a big deal for me. It was one chemo infusion treatment followed by several days of Neupogen injections that led up to the actual harvest. I live 200 miles from my transplant hospital, so I did all the tests that were asked for where I live. Bone survey, bone marrow biopsy, PFT, lots of labs, 24-hour urine collection, to name a few. It took two days and about 5 hours each day to collect 5 million cells. I was disappointed that I only collected 5 million in two days. Although enough for a transplant.
Due to family obligations and my wife having neurosurgery, I had to postpone my transplant. The plan now is to have it done in March. That's about two year's after harvest.
Bottom line: I would at least do the harvest and storage. Already mentioned was the insurance part. Some don't pay for extended storage. They want you to do the whole collection and transplant at one time. Also, if you're out of area for your insurance to cover the transplant, they might be contracted with only one hospital as mine was. I didn't have a choice where to go.
Another thing to consider is going to an approved transplant hospital and speaking with them directly with all your questions or concerns. They should have a booklet to give you on the procedures at that hospital.
Best of Luck,
Castaway
I was diagnosed in January 2014. Had treatments for that year leading up to a complete response around December. During that response, I had my cells harvested the first part of 2015. The stem cell harvest was not a big deal for me. It was one chemo infusion treatment followed by several days of Neupogen injections that led up to the actual harvest. I live 200 miles from my transplant hospital, so I did all the tests that were asked for where I live. Bone survey, bone marrow biopsy, PFT, lots of labs, 24-hour urine collection, to name a few. It took two days and about 5 hours each day to collect 5 million cells. I was disappointed that I only collected 5 million in two days. Although enough for a transplant.
Due to family obligations and my wife having neurosurgery, I had to postpone my transplant. The plan now is to have it done in March. That's about two year's after harvest.
Bottom line: I would at least do the harvest and storage. Already mentioned was the insurance part. Some don't pay for extended storage. They want you to do the whole collection and transplant at one time. Also, if you're out of area for your insurance to cover the transplant, they might be contracted with only one hospital as mine was. I didn't have a choice where to go.
Another thing to consider is going to an approved transplant hospital and speaking with them directly with all your questions or concerns. They should have a booklet to give you on the procedures at that hospital.
Best of Luck,
Castaway
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Harvest stem cells now or later?
Although the research is not entirely definitive on this, it is believed that it may be better to be in stringent complete response (sCR), or be minimal residual disease (MRD) negative, when collecting the cells. If at a lesser response, you may be reinfusing bad cells (or at least more of them) back in with the infusion of the stem cells.
Of course, most autologous stem cell transplants are done at the partial response (PR) or the very good partial response (VGPR) response, level, and they still improve outcomes, according to the studies. And, of course, maybe you would decide the autologous transplant is not needed based on the superior response, but you could freeze them for first relapse
If you are at best response already, and you postpone collection of cells, then, at the time they may be needed, you would collect them, which I will assume to be at first relapse. If you did not receive the same response at first relapse, then, arguably, the collected stem cells would not be as good (even if they were newer) than the older, frozen cells you could have had, based on level of residual disease.
It may that better response would be the reason that results are better at lower levels of residual disease. However, there is some research I recall at least in part attributing the outcomes to residual disease. At lower levels, the freezing / thawing process is believed to be detrimental to the multiple myeloma cells, but at a high enough concentration, they may survive the thawing / freezing process.
Of course, most autologous stem cell transplants are done at the partial response (PR) or the very good partial response (VGPR) response, level, and they still improve outcomes, according to the studies. And, of course, maybe you would decide the autologous transplant is not needed based on the superior response, but you could freeze them for first relapse
If you are at best response already, and you postpone collection of cells, then, at the time they may be needed, you would collect them, which I will assume to be at first relapse. If you did not receive the same response at first relapse, then, arguably, the collected stem cells would not be as good (even if they were newer) than the older, frozen cells you could have had, based on level of residual disease.
It may that better response would be the reason that results are better at lower levels of residual disease. However, there is some research I recall at least in part attributing the outcomes to residual disease. At lower levels, the freezing / thawing process is believed to be detrimental to the multiple myeloma cells, but at a high enough concentration, they may survive the thawing / freezing process.
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JPC - Name: JPC
Re: Harvest stem cells now or later?
There is no real evidence to support this, but it also seems to me that as a matter of common sense, it would be better to harvest stem cells when in first remission than after a relapse, on the basis that the harvested cells will be less contaminated by clonal cells.
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Davidg - Name: David
- When were you/they diagnosed?: Feb 2015 - AL Amyloidosis
- Age at diagnosis: 53
Re: Harvest stem cells now or later?
Hi David:
The article that I read was on a "preclinical study". As you note, not yet well developed. I will look for it and if I find it, I will post it. Regards,
The article that I read was on a "preclinical study". As you note, not yet well developed. I will look for it and if I find it, I will post it. Regards,
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JPC - Name: JPC
Re: Harvest stem cells now or later?
I had to make the same decision this summer. After 3 cycles of treatment with Kyprolis, Revlimid, and dexamethasone, my cancer was undetectable by blood, urine, and bone marrow tests. I was diagnosed without any physical symptoms or co-morbidities, but had greater than 50% cancerous plasma cells in my marrow. I'm 57, and as I like to say, I'm perfectly healthy ... except I have cancer.
So the fight began between my doctor, the transplant doctor, and me. From my standpoint, I didn't want to undergo a stem cell transplant and all of the side effects and long recovery time unless it was a "cure". My doctor was supportive of that decision, since the new class of proteasome inhibitor drugs are doing so well. The transplant doctor, who built the program at the hospital in the 1990's (it's his "baby") pushed for a transplant, arguing that he didn't want me to build up a resistance to the drugs I was using, and I was missing my best chance to go through a transplant. (In reading the waivers you need to sign to get a transplant, they explicitly say that the transplant will not prevent your multiple myeloma from coming back). I broke the tie vote by getting a 3rd opinion from Mayo. They too agreed that the drugs were the answer for now, and reminded me that having and treating multiple myeloma is a marathon, not a sprint.
In July, I had stem cells harvested and they are now in storage as my emergency insurance. I am continuing on the Kyprolis, Revlimid, and dexamethasone treatment, with 3 cycles yet to go. There is no indication of any cancer in my system, but as the doctor at Mayo said, "you are cancer free to the level we can test, but that doesn't mean you don't have cancer cells hiding in places only the drugs can reach".
In my case, I will go onto maintenance therapy (10 mg of Revlimid 21 out of 28 days) for at least 2 years, and play the wait and see game. I really feel that I made the right choice in harvesting the stem cells and holding them for the future. There are so many advances being made, and made rapidly, that I truly believe that I just have to stay healthy long enough for this disease to be treated only as a chronic pesky problem, or even be cured.
So the fight began between my doctor, the transplant doctor, and me. From my standpoint, I didn't want to undergo a stem cell transplant and all of the side effects and long recovery time unless it was a "cure". My doctor was supportive of that decision, since the new class of proteasome inhibitor drugs are doing so well. The transplant doctor, who built the program at the hospital in the 1990's (it's his "baby") pushed for a transplant, arguing that he didn't want me to build up a resistance to the drugs I was using, and I was missing my best chance to go through a transplant. (In reading the waivers you need to sign to get a transplant, they explicitly say that the transplant will not prevent your multiple myeloma from coming back). I broke the tie vote by getting a 3rd opinion from Mayo. They too agreed that the drugs were the answer for now, and reminded me that having and treating multiple myeloma is a marathon, not a sprint.
In July, I had stem cells harvested and they are now in storage as my emergency insurance. I am continuing on the Kyprolis, Revlimid, and dexamethasone treatment, with 3 cycles yet to go. There is no indication of any cancer in my system, but as the doctor at Mayo said, "you are cancer free to the level we can test, but that doesn't mean you don't have cancer cells hiding in places only the drugs can reach".
In my case, I will go onto maintenance therapy (10 mg of Revlimid 21 out of 28 days) for at least 2 years, and play the wait and see game. I really feel that I made the right choice in harvesting the stem cells and holding them for the future. There are so many advances being made, and made rapidly, that I truly believe that I just have to stay healthy long enough for this disease to be treated only as a chronic pesky problem, or even be cured.
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kdaneedgar - Name: kdane
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 56
9 posts
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