Drs. Siegel and Vesole,
Thank you for taking time to answer questions in the forum.
My question concerns my husband who was diagnosed with high risk myeloma in June of last year. He obtained complete remission with induction chemotherapy, followed by allogeneic BMT in February of this year. His 3 month bone marrow showed continued remission however his gene rearrangement studies were positive.
Should he be considered for maintenance therapy, and if so when?
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Re: Maintenance therapy in high risk myeloma
I am uncertain what you mean by 'the gene rearrangement studies were positive". Have they done tests to see if his blood cells are 100% donor or is does he have a mixed result with some cells his and some cells donor.
Regardless, there is little information regarding maintenance therapy after transplant in patients in remission. There is a Dutch study which was presented previously utilizing Relvimid maintenance. The study was terminated early because of increased incidence of graft-versus-host-disease. A similar study is on-going in the US.
So, unfortunately, there is no answer to the question at this time as our knowledge in this arena is limited. Further, it has not been shown that Revlimid improves outcomes in high risk myeloma, even after autologous transplant. Studies are being developed to analyze Velcade maintenance in high risk disease.
Regardless, there is little information regarding maintenance therapy after transplant in patients in remission. There is a Dutch study which was presented previously utilizing Relvimid maintenance. The study was terminated early because of increased incidence of graft-versus-host-disease. A similar study is on-going in the US.
So, unfortunately, there is no answer to the question at this time as our knowledge in this arena is limited. Further, it has not been shown that Revlimid improves outcomes in high risk myeloma, even after autologous transplant. Studies are being developed to analyze Velcade maintenance in high risk disease.
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Dr. David Vesole - Name: David H. Vesole, M.D., Ph.D., F.A.C.P.
Re: Maintenance therapy in high risk myeloma
Sorry for the confusion. His chimerism studies showed 100% donor cells.
What I meant to report as positive was his B-cell gene rearrangement being positve for both heavy and light chain monoclonality by PCR assay and capillary gel electrophoresis...not sure of the significance of this at this point in his recovery(day 90 post transplant).
In any case it appears that the answer to our question awaits future clinical study.
Thank you.
What I meant to report as positive was his B-cell gene rearrangement being positve for both heavy and light chain monoclonality by PCR assay and capillary gel electrophoresis...not sure of the significance of this at this point in his recovery(day 90 post transplant).
In any case it appears that the answer to our question awaits future clinical study.
Thank you.
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