[Benny]

Induction without stem cell transplant - is it common?

by Benny on Sat Dec 10, 2016 10:22 am

Hi:

I am 45 year old man. I was diagnosed Friday, December 2, 2016, I live in Wisconsin and am being treated at the University of Wisconsin - Madison.

I had a bone marrow biopsy this past Wednesday.
.
My skeletal films showed no lesions, but my labs were unusual

Hematocrit 30 (L)

IgA 12 (L) 63 - 484 mg/dL
IgG 10312 (H) 540 - 1822 mg/dL
IgM 7 (L) 22 - 240 mg/dL

B2-Microglob 3.9 (H) 1.0 - 2.6 mg/L

Immunofixation showed IgG kappa.

I am waiting for the genetic testing but was offered a clinical trial with triplet therapy if I am standard risk. If I am high risk, I would go right to Kyprolis, Revlimid, and dexamethasone (KRD).

The main issue is that my center prefers to hold back on the autologous stem cell transplant. It only comes into play if I do not respond to the above

Is this a common approach?

[Benny]

Re: Induction without stem cell transplant - is it common?

by Benny on Sat Dec 10, 2016 1:43 pm

Got an update. My FISH showed standard risk genetics with lots of "trisomy," which I was told was good.

So the plan is to start next week in a trial comparing Kyprolis, Revlimid, and dexa­metha­sone (KRD) versus Velcade, Revlimid, and dexa­metha­sone (VRD, RVD). Stem cells will be harvested at month 4 and I have the option to transplant at anytime if I am not doing well or decide that's best.

[PositiveChris]

Re: Induction without stem cell transplant - is it common?

by PositiveChris on Sat Dec 10, 2016 3:45 pm

Best of luck Benny,

I'm on the same path you are, waiting on my FISH analysis. Starting Revlimid, Velcade, and dexa­metha­sone (RVD) on Tuesday, but we may switch it to Kyprolis, Revlimid, and dexa­metha­sone (KRD). Current plan is an autologous stem cell transplant (ASCT) after 4 cycles or so.

Look forward to sharing stories and learnings.

Much Love

[Mark11]

Re: Induction without stem cell transplant - is it common?

by Mark11 on Sat Dec 10, 2016 4:05 pm

Hi Benny,

You asked:

Is this a common approach?

Very common. In the US in 2010, only 12.4% of patients did an auto within the first year of diagnosis. As you can see from the studies in this thread, it is not very common for a patient in the US to do an auto in the first year of diagnosis:

"Autologous stem cell transplants in the United States" (started Nov 11, 2015)

Mark

[K_Shash]

Re: Induction without stem cell transplant - is it common?

by K_Shash on Sat Dec 10, 2016 5:23 pm

Hi Benny,

I have an IgG kappa multiple myeloma, 'trisomy' only (in my cytogenetics test). I have opted against an early transplant. The stem cell harvest was not an option for me, as I found out later.

Please refer to the mSMART guidelines from the Mayo Clinic, which I've attached.

You may also find the discussions on the following topics of interest.

"SCT or no SCT - a confusing decision" (started Apr 29, 2015)

"Stem cell harvest at 68 & transplant at 75 - why bother?" (started Jan 15, 2015)

Attachments

msmart-2016-07.pdf

(337.18 KiB) Downloaded 38 times

[Benny]

Re: Induction without stem cell transplant - is it common?

by Benny on Sat Dec 10, 2016 5:51 pm

Thanks to all! It is SO helpful to have this community. I will update and stay in touch. Be well!