Forums
9 posts
• Page 1 of 1
Number of minimal stem cells harvested
My question is what should the minimal number of stem cells collected for 2 transplants??? At md anderson their minimal collection for each transplant is 5 million but they collect for a minimum of 10 miliion even if that means 4 days on a aphesis machine where here in Wichita Ks they say they only do 1 day of the machine as long as they get 2 million for 1 transplant but take 4 million for a 2nd storage plant. They say they do not need 5 million. Do I need to be worried at these differences????? My husband is being harvested tomorrow and really want him to collect 10 million while he has that port in even if it means 2 days on aphesis machine collecting. Are there any more risks being on a machine for 2 days or is that risk worth the higher number????
-
dlnelson3 - Name: Deb
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 20,2012
- Age at diagnosis: 65
Re: Number of minimal stem cells harvested
Hi !
Great question and I can see why this is concerning for you.
A widely accepted absolute minmum number per transplant is 2 million stem cells cells per kilogram of the patients body weight. But most centers would like to have 5 million per transplant if that number can be collected. The rapidity of bone marrow recovery post transplant (engraftment) and the "robustness" of engraftment may be improved with higher numbers. In practice patients are routinely transplanted with anything from 2-5 million cells per transplant. I would not worry unless he cannot collect at least 2 million cells and therefore have an adequate number for at least 1 transplant. There is no abosultely right answer. Both centers are correct.
Good luck in you and your husband's battle with this difficult disease !
Great question and I can see why this is concerning for you.
A widely accepted absolute minmum number per transplant is 2 million stem cells cells per kilogram of the patients body weight. But most centers would like to have 5 million per transplant if that number can be collected. The rapidity of bone marrow recovery post transplant (engraftment) and the "robustness" of engraftment may be improved with higher numbers. In practice patients are routinely transplanted with anything from 2-5 million cells per transplant. I would not worry unless he cannot collect at least 2 million cells and therefore have an adequate number for at least 1 transplant. There is no abosultely right answer. Both centers are correct.
Good luck in you and your husband's battle with this difficult disease !
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Number of minimal stem cells harvested
As another point of reference - I am being treated at the University of Michigan and had my stem cells harvested last August. UofM indicated they wanted to get 3M/KG. I ended up collecting 9.4M over three days, so depending on how many are used for the transplant, this gives me enough for at least two, and perhaps three SCTs if needed.
I don't think there's any significant risk going more than one day. The main issue for me was just the wear and tear. Between the Neupogen and Mozobil they gave me to increase stem cell production, I got very little sleep due to nausea and a lot of muscle and bone aches. By the end of the third day, I was wiped out. Note - I seemed to be the exception going three days. The other patients that started on the same day as me all collected enough the first day and did not need to come back.
I don't think there's any significant risk going more than one day. The main issue for me was just the wear and tear. Between the Neupogen and Mozobil they gave me to increase stem cell production, I got very little sleep due to nausea and a lot of muscle and bone aches. By the end of the third day, I was wiped out. Note - I seemed to be the exception going three days. The other patients that started on the same day as me all collected enough the first day and did not need to come back.
-
Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
Re: Number of minimal stem cells harvested
Hi Kevin,
Just curious, were all the patients including you on lenalidomide prior to apheresis?
It is interesting that, plerixafor did not seem to enhance stem cell mobilization in your case.
Just curious, were all the patients including you on lenalidomide prior to apheresis?
It is interesting that, plerixafor did not seem to enhance stem cell mobilization in your case.
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Number of minimal stem cells harvested
Good Morning SuzieRose,
In answer to your question to Kevin and I don't mean to step on his toes, I was on Revlimid before apheresis because the Velcade and Doxil and Dex didn't lower the counts to the level the doc's wanted to see going into the sct. I had 3 or 4 cycles of Rev.
I had Nuelasta instead of Nuepogen which was only 1 shot. I didn't have any problems with collection. On the machine 3.5 hrs one day for 7.1 mil. and 1.5 hrs. scd. day for 2.1 mil.
ritz
In answer to your question to Kevin and I don't mean to step on his toes, I was on Revlimid before apheresis because the Velcade and Doxil and Dex didn't lower the counts to the level the doc's wanted to see going into the sct. I had 3 or 4 cycles of Rev.
I had Nuelasta instead of Nuepogen which was only 1 shot. I didn't have any problems with collection. On the machine 3.5 hrs one day for 7.1 mil. and 1.5 hrs. scd. day for 2.1 mil.
ritz
-
Ritz - Name: Ritz
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Oct 2010
- Age at diagnosis: 62
Re: Number of minimal stem cells harvested
Hi Ritz,
No problem about your response, we learn a lot here at the forum, because everyone contributes.
I was just wondering if Kevin was unique amongst the group he spoke of ..as I know he is on lenalidamide, but didn't know if the others he referred to had also been on lenalidamide.
There is a lot of patient variability that is seen even when patients all have the same induction and mobilization of agents.
I was on lenalidamide for 6 cycles prior to my cells being harvested and both Neupogen and Mobizil (plerixfor) were used as Kevin noted he received too.
No problem about your response, we learn a lot here at the forum, because everyone contributes.
I was just wondering if Kevin was unique amongst the group he spoke of ..as I know he is on lenalidamide, but didn't know if the others he referred to had also been on lenalidamide.
There is a lot of patient variability that is seen even when patients all have the same induction and mobilization of agents.
I was on lenalidamide for 6 cycles prior to my cells being harvested and both Neupogen and Mobizil (plerixfor) were used as Kevin noted he received too.
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Number of minimal stem cells harvested
suzierose,
My stem cell collection was performed between my 5th and 6th cycles, so I had been on Revlimid for five cycles. I do not know whether any of the others collecting stem cells at the same time as me were on Revlimid (at least one was not since he had an entirely different type of cancer). I gave myself Neupogen injections for four days leading up to the collection, and that didn't seem to do much to stimulate production. I was given the Mozobil after the 1st and 2nd collections and that seemd to do the trick.
My stem cell collection was performed between my 5th and 6th cycles, so I had been on Revlimid for five cycles. I do not know whether any of the others collecting stem cells at the same time as me were on Revlimid (at least one was not since he had an entirely different type of cancer). I gave myself Neupogen injections for four days leading up to the collection, and that didn't seem to do much to stimulate production. I was given the Mozobil after the 1st and 2nd collections and that seemd to do the trick.
-
Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
Re: Number of minimal stem cells harvested
Kevin
As you have reached an sCR (happy to hear), I am curious to hear what Jakubowiak’s general plan is for maintenance after you have completed all cycles.
Could it be no drugs at all, provided perhaps that your cytogenetics are low-risk? This would be akin to what Mayo does with low-risk patients after an ASCT.
As you have reached an sCR (happy to hear), I am curious to hear what Jakubowiak’s general plan is for maintenance after you have completed all cycles.
Could it be no drugs at all, provided perhaps that your cytogenetics are low-risk? This would be akin to what Mayo does with low-risk patients after an ASCT.
-
Dan D
Re: Number of minimal stem cells harvested
Dan D,
The current recommendation is to continue maintenance therapy with Revlimid only. I'm still weighing that option based on what insurance will cover, the concern for secondary cancers due to Revlimid, and also recent research regarding the need for maintenance therapy for people who have had a molecular level response (see the forum on "Precision Medicine will be in Action @ ASCO 2012"). I'm still weeding through all the reference in the forum, but at least some are of the opinion there is little to offer from continued maintenance if you've reached molecular response, which I have.
With respect to the cytogenetics, I am fortunate not to have any of the abnormalities associated with poorer prognosis, nor to date have I had any of the various other indicators that have been associated with poorer prognosis (I'm currently working on collecting data on the various different factors affecting prognosis for a future column).
The current recommendation is to continue maintenance therapy with Revlimid only. I'm still weighing that option based on what insurance will cover, the concern for secondary cancers due to Revlimid, and also recent research regarding the need for maintenance therapy for people who have had a molecular level response (see the forum on "Precision Medicine will be in Action @ ASCO 2012"). I'm still weeding through all the reference in the forum, but at least some are of the opinion there is little to offer from continued maintenance if you've reached molecular response, which I have.
With respect to the cytogenetics, I am fortunate not to have any of the abnormalities associated with poorer prognosis, nor to date have I had any of the various other indicators that have been associated with poorer prognosis (I'm currently working on collecting data on the various different factors affecting prognosis for a future column).
-
Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
9 posts
• Page 1 of 1