[orchid]

How many treatment cycles before stem cell transplant?

by orchid on Tue Apr 22, 2014 11:37 pm

Hi All,

My brother is almost done with the fourth cycle of CyBord [cyclophosphamide (Cytoxan), Velcade (bortezomib), and dexamethasone], and the doctor is talking about preparation for an autologous stem cell transplant (ASCT).

The doctor is encouraged that she saw the M-spike at 4 as of the second cycle blood test (my brother had an M-spike of 33 before treatment), which is a very good result in 2 cycles

Now the result of the 3rd cycle blood test indicates that the improvement in M-spike has slowed down significantly, it is at 3.1 from 4. The IgA went to a low level (before treatment it was 35.65) as of the 3rd cycle blood result, it is on the border of being acceptable at 4.7.

My question: Is it advisable to go into the ASCT even if the M-spike does not get to zero or 1?.

The doctor seems to be willing to do it by the mere fact that we are below 4.

Is it better to try more cycles (beyond 4) to bring M-Spike down to close to zero, or is that not necessary? If that is not necessary, why bother with the induction treatment?

Thanks in advance for your insight on this question.

[kjpoppit]

Re: How many treatment cycles before stem cell transplant?

by kjpoppit on Wed Apr 23, 2014 7:28 am

Hi, I did 4 cycles of CyBorD. I responded best after the first cycle, and then only minimal decreases were seen. Of course it is best to get to zero, but I stopped progressing. I am about to have my auto transplant. I have a 0.2 M-spike now. They are going to give me a high dose of Cytoxan along with the Neupogen shots. I think this is common. Best of luck to your brother.

Kim

[Steve Mohr]

Re: How many treatment cycles before stem cell transplant?

by Steve Mohr on Wed Apr 23, 2014 11:41 am

Hi Orchid - I am currently on my 6th cycle (Rev/Dex/Zometa) and have a stem cell transplant scheduled for June. I have had a very positive response to treatment, although none of the numbers are at 0 yet. I'm not remotely qualified to answer the questions you ask but will say that my doctor has indicated that I will stay on my current regimen pretty much through the month of May. Based on the trend of the numbers, I doubt that they will be at 0 before the transplant. Good luck!

[orchid]

Re: How many treatment cycles before stem cell transplant?

by orchid on Wed Apr 23, 2014 11:43 pm

Thanks both Kim and Rooskie for your thoughts and wishes. I wish you both good results with your ASCTs.

[NStewart]

Re: How many treatment cycles before stem cell transplant?

by NStewart on Thu Apr 24, 2014 11:32 am

I was on a regimen of 15 mg Revlimid, 40 mg dexamethasone, and Zometa infusions before my ASCT. I reached stable disease of 0.5 mg/dl m-spike when I had my transplant. From what I understand, not everyone will reach 0 prior to the transplant. Stable disease is a good point to do the transplant.

I had 8 cycles of treatment before my transplant by my choice. My decision was based on when my support could come and stay with me for 6 weeks, not on anything else. My oncologist had said that anywhere from 6 to 18 cycles of my regimen was optimal timing for the transplant. This was in 2009 when I had induction.

All the best to your brother,
Nancy in Phila

[Christa's Mom]

Re: How many treatment cycles before stem cell transplant?

by Christa's Mom on Thu Apr 24, 2014 12:47 pm

EJ was on Velcade and dex as his induction therapy. After 6 cycles, his m-spike went from 2.7 mg/dl to 0.9. However, the doc was more or equally interested in the percent of plasma cells in his bone marrow. At diagnosis it was 30 - 40% involvement, but the Velcade/dex brought it down to less than 10% involvement.

Good luck,

Lyn

[Nancy Shamanna]

Re: How many treatment cycles before stem cell transplant?

by Nancy Shamanna on Thu Apr 24, 2014 2:20 pm

Hi Orchid, It sounds like your brother had great results with the induction regimen of Velcade/dex. From a value of 33 to 4 seems good.

I think that the need for induction is to clear out as much of the 'tumour burden' as possible before harvesting the stem cells for the ASCT. Those cells are going to be replaced into ones bloodstream, and then migrate into the bone marrow, and create the new blood cells, so the idea is to get them as healthy as possible.

Also, with Velcade, the doctor is probably a bit worried about your brother developing neuropathy from the treatments. That is a side effect of Velcade sometimes, so the number of cycles may be limited. Hope that helps!

[Tough Mom]

Re: How many treatment cycles before stem cell transplant?

by Tough Mom on Sat Apr 26, 2014 7:45 am

Another factor that has to be taken into consideration is the effect of continuing treatment on stem cell harvest. Most drugs that work against myeloma also affect the stem cells. Alkylating agents like melphalan cannot be given prior to stem cell harvest at all, and drugs like thalidomide and lenalidomide (Revlimid) lower the yield of stem cells. Cyclophosphamide (Cytoxan) also has this effect. There are some articles within the Beacon talking about this:

https://myelomabeacon.org/news/2010/08/04/combination-of-thalidomide-thalomid-and-cyclophosphamide-may-negatively-impact-stem-cell-collection/

So the goal of induction therapy for a patient who is going on to have a stem cell transplant isn't actually to get to a "zero" number, but to achieve as deep a response as possible while allowing a sufficient number and quality of stem cells to be collected. You and your doctor have to balance those goals, along with side effects, as Nancy mentions, but that's why typically induction is 4- 6 cycles.

[orchid]

Re: How many treatment cycles before stem cell transplant?

by orchid on Tue Apr 29, 2014 12:34 am

Thanks all for your sharing your experiences and thoughts. It is greatly appreciated