Hi Phoebe,
A "mini" allo is indeed a potential cure for blood cancer patients. I do not like the name though. I do not think there is anything "mini" about transplanting a healthy functioning donor immune system into a cancer patient that has a poorly functioning immune system.
Basically a "mini" allo uses a minimal amount of conditioning to suppress the patients immune system so that donor cells can come in and form a new, healthy immune system. Sometimes just radiation is used. A drug called fludarabine is commonly used as well
"Less intense conditioning regimens are being used more frequently today that retain the desirable effects of standard high-dose conditioning regimens, but with significantly lower transplant-related mortality (TRM).
The adoption of less toxic conditioning regimens has expanded the number of patients eligible to receive transplants -- patients who may have previously been excluded due to older age or existing co-morbidities. Today, patients to their 70s are receiving transplants. For more information, see Trends in Allogeneic Transplants.
Reduced-intensity regimens
Reduced-intensity or non-myeloablative regimens use lower doses of pre-transplant chemotherapy drugs and/or radiation than the traditional high-dose, myeloablative regimens that have been in use for more than 40 years.
These regimens do not necessarily completely eliminate malignant cells prior to transplant, but instead rely upon a graft-versus-malignancy effect mediated by donor-origin lymphoid cells, mostly T cells. Clinical studies of reduced-intensity transplantation have shown that the graft-versus-malignancy effect is particularly pronounced in:
Chronic myelogenous leukemia
Chronic lymphocytic leukemia
Low-grade, indolent lymphomas [1]
Reduced-intensity regimens typically use combinations of chemotherapy drugs such as fludarabine, busulfan, and melphalan, with or without low-dose radiation. Due to the reduced toxicity of these regimens, TRM can be lower, and may result in improved outcomes. Recent studies comparing reduced-intensity transplants to fully myeloablative transplants have also shown:
Survival in older patients after reduced-intensity transplants is comparable to survival in younger transplant patients. [2,3]
No significant difference in non-relapse mortality and overall survival between patients older than 55 years and those younger than 55. [4]
Significantly lower 1-year infection-related mortality after reduced-intensity transplantation than after myeloablative transplantation. [5]
Some transplant centers are also performing autologous transplants followed by reduced-intensity allogeneic transplantation. This strategy combines the tumor cytoreduction of a high-dose autologous transplant with the lowered TRM of a reduced-intensity conditioning regimen. This technique has been particularly promising in treating patients with multiple myeloma. [6,7]"
http://marrow.org/Physicians/Transplant_Advances/Preparative_Regimens.aspx
In myeloma and many other blood cancers, allo transplant is the only possible cure. I did an allo with a more intensive regimine than the typical auto "transplant" because I am a younger patient. "Mini" allos are an attempt to cure older patients that have no other curative option.
Mark
Forums
Re: High risk multiple myeloma, pls share your story
Thanks much, Mark. Very informative.
I asked my dad's doctor about allo transplant too when my dad was first diagnosed with myeloma... but she discouraged me strongly against it, citing the huge risk involved.
I asked my dad's doctor about allo transplant too when my dad was first diagnosed with myeloma... but she discouraged me strongly against it, citing the huge risk involved.
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Phoebe - Who do you know with myeloma?: dad
- Age at diagnosis: 62
Re: High risk multiple myeloma, pls share your story
Hello!
My mom is on her 2nd cycle of chemo for Multiple Myeloma. She was diagnosed with Multiple Myeloma due to kidney failure. Her bone biopsy results came back a couple days ago and we found out she is considered high risk due to her cytogenetics. She has already been in the hospital for 3 weeks and it sounds like they are planning on hitting her at least 2 more rounds of chemo and then preparing her for a bone marrow transplant. She is not feeling very hopeful. The constant hospital time alone is enough to dampen her spirit. I was wondering home many people with high risk multiple myeloma were able to do their chemo as outpatients?
My mom is on her 2nd cycle of chemo for Multiple Myeloma. She was diagnosed with Multiple Myeloma due to kidney failure. Her bone biopsy results came back a couple days ago and we found out she is considered high risk due to her cytogenetics. She has already been in the hospital for 3 weeks and it sounds like they are planning on hitting her at least 2 more rounds of chemo and then preparing her for a bone marrow transplant. She is not feeling very hopeful. The constant hospital time alone is enough to dampen her spirit. I was wondering home many people with high risk multiple myeloma were able to do their chemo as outpatients?
Re: High risk multiple myeloma, pls share your story
Dad has high risk (p53) multiple myeloma. He has been an outpatient for about 1+ year. He's now in remission. He's 1.5 years post diagnosis, 3 years post his first compression fracture. Stem cell was collected, but no ASCT yet.
He will have one or two more cycles of treatment, then we will proceed to maintenance. Hopefully the remission will continue for as long as God permits.
Cheer up! We have a great advancement in terms of multiple myeloma therapies! The Doctor will work with you to find the treatment that suits your Mom!
He will have one or two more cycles of treatment, then we will proceed to maintenance. Hopefully the remission will continue for as long as God permits.
Cheer up! We have a great advancement in terms of multiple myeloma therapies! The Doctor will work with you to find the treatment that suits your Mom!
Re: High risk multiple myeloma, pls share your story
Hi. I am new to all of this. I was diagnosed in dec 2012 with high risk t53. Stem cell transplant scheduled for 5/28. Was treated with velcaide but developed a rare side effect and had to discontinue. It is really difficult to find others w tp53 at diagnosis. I am told all the time it is a very big concern in terms of poor prognosis and overall survival. I am enrolled in a clinical trial in Maryland at NIH (t cell). I am looking for others that did well despite tp53. Please keep me posted on your day's progress. God BLess.
Re: High risk multiple myeloma, pls share your story
Phoebe wrote:
> Thanks for all the posts, sharing your story or views.
>
> Can anyone let me know what is a mini allo? Why is it mini? Sounds like a
> mini cure!
You may find this perspective on allos and min-allos to be insightful. This was just posted by Dr. Drurie yesterday. They have their place in some unique situations.
https://www.youtube.com/watch?v=zTwcR0DZ2mI&feature=youtube_gdata_player
> Thanks for all the posts, sharing your story or views.
>
> Can anyone let me know what is a mini allo? Why is it mini? Sounds like a
> mini cure!
You may find this perspective on allos and min-allos to be insightful. This was just posted by Dr. Drurie yesterday. They have their place in some unique situations.
https://www.youtube.com/watch?v=zTwcR0DZ2mI&feature=youtube_gdata_player
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High risk multiple myeloma, pls share your story
Due to various infections following stemcell collection in november, dad had to postpone the sct until early july, this year. His latest treatment was in end of january; at that time, his kappa was 40. Upper resp infections made him unable to continue treatment for 3-4 months. We tested for his kappa again in end of april, 3 months after his last injection. His kappa was "only" 122. Doc said it was not that bad, as in, with p53, 3 mo without treatment would have made the numbers skyrocketed. He had Velcade right after the diagnosis. Velcade might tame p53 trait.
Life suddenly becomes brighter. Stay strong!
Life suddenly becomes brighter. Stay strong!
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