I have been on 3 cycles of cyclophosphamide, Velcade, prednisone induction therapy.
Two weeks afterwards (on February 11), I received a larger dose of cyclophosphamide in preparation for stem cell removal.
My stem cells were harvested on February 23.
My stem cell transplant will be on April 1st, which will be 7 weeks after my last chemo treatment (Feb 11).
Do people know if 7 weeks is a long time not to have any chemo treatment at all prior to a stem cell transplant?
Between diagnosis and February 11, my M spike went from 35 g/L to 3 g/L [3.5 g/dL to 0.3 g/dL], and I have a deletion 17.
Thanks for any input.
Ping
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Re: Transplant 7 weeks after last treatment - is that long?
Good Morning, Ping:
You are in a similar situation to my wife, although she does not have del(17p). We are at about Day 23 post ASCT, and she is doing well, thank God.
We were 6 weeks in between last induction round and the ASCT. If you have Revlimid in the treatment, then they need to wait about 3 weeks for collection. With all the logistics, and allowing collection for a whole week, it is about 5 to 6 weeks for the minimum time anyway, so 7 is reasonable. Although, since you used Cytoxan instead of Revlimid, I imagine it could have possibly been shorter.
Looks like you are using the Canadian metric for the M-spike, which is x10 the U.S. metric. But, using the U.S. metric, there are two things that might result in a little higher M-spike reading.
First, there is measurement error. We were advised that could be 0.1.
Second, the medicines they use to assist in the collection of stem cells, Neupogen and Mozobil, they "flush" the "stuff" our of the bone marrow and into the blood. This is noted on the drug disclosure that you could look up on the Internet. It appears that you might go up 0.1 or 0.2 from these factors, and it would not necessarily be anything abnormal. In fact, we went up by a little less than 0.1, which was a little disturbing at first, but after discussion and analysis is no big deal.
If you have decided to go with the autologous stem cell transplant (ASCT), if it did go up even by a lot, I do not see any result that would make you change that course. (Of course, that is something you should discuss with your doctor.). If it went up, it probably would be a bigger driver to do the ASCT, but again, speak with your doctor.
You should read the study by Dr. Sagar Lonial (Winship Cancer Institute) published September of last year. That study reported the best results with respect to del(17p) to date. It used Revlimid, Velcade, and dexamethasone (RVD) maintenance continuously. Very roughly, it appears to be about half the dosage of induction therapy, so it's a lot compared to other maintenance approaches, but Dr. Lonial reported far better del(17p) results than anything to date.
Best of luck to you in the ASCT and the aftermath.
You are in a similar situation to my wife, although she does not have del(17p). We are at about Day 23 post ASCT, and she is doing well, thank God.
We were 6 weeks in between last induction round and the ASCT. If you have Revlimid in the treatment, then they need to wait about 3 weeks for collection. With all the logistics, and allowing collection for a whole week, it is about 5 to 6 weeks for the minimum time anyway, so 7 is reasonable. Although, since you used Cytoxan instead of Revlimid, I imagine it could have possibly been shorter.
Looks like you are using the Canadian metric for the M-spike, which is x10 the U.S. metric. But, using the U.S. metric, there are two things that might result in a little higher M-spike reading.
First, there is measurement error. We were advised that could be 0.1.
Second, the medicines they use to assist in the collection of stem cells, Neupogen and Mozobil, they "flush" the "stuff" our of the bone marrow and into the blood. This is noted on the drug disclosure that you could look up on the Internet. It appears that you might go up 0.1 or 0.2 from these factors, and it would not necessarily be anything abnormal. In fact, we went up by a little less than 0.1, which was a little disturbing at first, but after discussion and analysis is no big deal.
If you have decided to go with the autologous stem cell transplant (ASCT), if it did go up even by a lot, I do not see any result that would make you change that course. (Of course, that is something you should discuss with your doctor.). If it went up, it probably would be a bigger driver to do the ASCT, but again, speak with your doctor.
You should read the study by Dr. Sagar Lonial (Winship Cancer Institute) published September of last year. That study reported the best results with respect to del(17p) to date. It used Revlimid, Velcade, and dexamethasone (RVD) maintenance continuously. Very roughly, it appears to be about half the dosage of induction therapy, so it's a lot compared to other maintenance approaches, but Dr. Lonial reported far better del(17p) results than anything to date.
Best of luck to you in the ASCT and the aftermath.
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JPC - Name: JPC
Re: Transplant 7 weeks after last treatment - is that long?
Just as an FYI for those who may be interested, the study by Dr. Sagar Lonial and his colleagues at Emory's Winship Cancer Center that JPC mentions in his posting is summarized in this Beacon news article:
"Extended Post-Transplant Treatment With Revlimid, Velcade, And Dexamethasone Yields High Survival Rates In High-Risk Myeloma," The Myeloma Beacon, Nov 26, 2013.
One of the co-authors of the study, Dr. Jonathan Kaufman, is a Beacon Medical Advisor. He posts regularly here in the Beacon's forum. This link will take you to a list of Dr. Kaufman's forum postings.
"Extended Post-Transplant Treatment With Revlimid, Velcade, And Dexamethasone Yields High Survival Rates In High-Risk Myeloma," The Myeloma Beacon, Nov 26, 2013.
One of the co-authors of the study, Dr. Jonathan Kaufman, is a Beacon Medical Advisor. He posts regularly here in the Beacon's forum. This link will take you to a list of Dr. Kaufman's forum postings.
Re: Transplant 7 weeks after last treatment - is that long?
Ping, I had six weeks off before SCT. They told me that was standard, to allow the body to recover from treatment. And, yes, my numbers did rise some during that time, but settled back down after the transplant. I do not have del 17.
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Transplant 7 weeks after last treatment - is that long?
Hi,
My dad delayed the ASCT for almost three months before proceeding to ASCT (he was afraid with the whole process). Last kappa light chain reading was in the upper 40s. Three months prior it was in the lower 30s. He does not secrete M-spike. He also has del(17p).
It has been almost 20 months since ASCT without maintenance. His numbers have started to crawl up – now at the upper 20s.
I think with Velcade, del(17p) is not as bad anymore, though still on the tougher side. You need not worry about the timing – seven weeks are reasonable. Theoretically, the best is to do ASCT when the numbers are at their lowest. It does make a difference versus doing it some time after the last injection, but probably not a night-and-day difference (so my doctor said).
And in our case, we did the harvest over a year before the ASCT. Again, Dad was scared, very reasonable. Our induction was Velcade, thalidomide, and dex (VTD). He did not respond well to cyclophospamide. But his readings did come down significantly from 70s to 40s after stem cell harvest. High dose cyclo (for stem cell mobilization) has a pretty strong anti-myeloma effect. And we notice that, after that, his response to Velcade was deeper.
Anyhow, good luck with your transplant. God bless.
My dad delayed the ASCT for almost three months before proceeding to ASCT (he was afraid with the whole process). Last kappa light chain reading was in the upper 40s. Three months prior it was in the lower 30s. He does not secrete M-spike. He also has del(17p).
It has been almost 20 months since ASCT without maintenance. His numbers have started to crawl up – now at the upper 20s.
I think with Velcade, del(17p) is not as bad anymore, though still on the tougher side. You need not worry about the timing – seven weeks are reasonable. Theoretically, the best is to do ASCT when the numbers are at their lowest. It does make a difference versus doing it some time after the last injection, but probably not a night-and-day difference (so my doctor said).
And in our case, we did the harvest over a year before the ASCT. Again, Dad was scared, very reasonable. Our induction was Velcade, thalidomide, and dex (VTD). He did not respond well to cyclophospamide. But his readings did come down significantly from 70s to 40s after stem cell harvest. High dose cyclo (for stem cell mobilization) has a pretty strong anti-myeloma effect. And we notice that, after that, his response to Velcade was deeper.
Anyhow, good luck with your transplant. God bless.
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