Hi, My partner has plasma cell leukaemia and has been treated with Revlimid/Dex/Cyclophosphamine over 6 cycles. The recent attempt at stem cell harvesting failed and he's been told they will try again using Mozobil (plerixafor) - I've just been reading the info on this drug and it says it shouldn't be used for patients with plasma cell leukaemia. If that's the case, why is our doc saying it should go ahead? Is there anything else we could try. I'm so scared that he won't get SCT.
Sue
Forums
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
Re: Plasma cell leukaemia stem cell collection failed - help
Hello,
The concern you have is probably related to the statement in the package insert that Mozobil should not be used in leukemia patients. Plasma cell leukemia is somewhat different from the leukemias they are referring to but in fact it is not clear how and if this will make matters worse in a myeloma patient. Many centers (including ours) are actually using Mozobil with chemotherapy to improve treatment outcomes in leukemia and lymphoma. The idea is that if you can get the cancer to leave the marrow then it may be more suceptible to chemotherapy. These are research studies of course but a very provocative idea. I do not see an absolute contraindication to Mozobil in plasma cell leukemia.
The concern you have is probably related to the statement in the package insert that Mozobil should not be used in leukemia patients. Plasma cell leukemia is somewhat different from the leukemias they are referring to but in fact it is not clear how and if this will make matters worse in a myeloma patient. Many centers (including ours) are actually using Mozobil with chemotherapy to improve treatment outcomes in leukemia and lymphoma. The idea is that if you can get the cancer to leave the marrow then it may be more suceptible to chemotherapy. These are research studies of course but a very provocative idea. I do not see an absolute contraindication to Mozobil in plasma cell leukemia.
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Plasma cell leukaemia stem cell collection failed - help
Thank you very much for that, it seems a bit more positive than we thought and makes us feel a lot better than we did a few hours ago! The leaflet we have does actually say plasma cell leukaemia as well as other leukaemias, but it's useful to know that getting it out of the marrow might have benefits too. Thanks again. Sue
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
Re: Plasma cell leukaemia stem cell collection failed - help
sue-a
You may also want to ask/investigate whether the Mozobil warning is for prolonged treatment of the leukemia vs. the one or possibly two injections you'd receive for the stem cell collection. When I went through the stem cell collection, I only collected 0.5 million stem cells per kilogram of body weight the first day. I received the Mozobil injection that evening to stimulate stem cell production and collected 5.5 M/Kg the next day.
You may also want to ask/investigate whether the Mozobil warning is for prolonged treatment of the leukemia vs. the one or possibly two injections you'd receive for the stem cell collection. When I went through the stem cell collection, I only collected 0.5 million stem cells per kilogram of body weight the first day. I received the Mozobil injection that evening to stimulate stem cell production and collected 5.5 M/Kg the next day.
-
Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
Re: Plasma cell leukaemia stem cell collection failed - help
Thanks for your help Kevin.
Unfortunately it turned out that my partner wasn't sent for stem cell collection. He was given the Mozobil injection but needed blood in the night and was then told in the morning that he wouldn't be going. His blood count (presumably WBC) was too low and the doc said the myeloma must be coming back. They have started him on Velcade with dex and cyclophosphamide, but we don't know much detail yet.
Does anyone know if it's possible to have stem cells collected after a relapse (presumably) and further chemo?
Unfortunately it turned out that my partner wasn't sent for stem cell collection. He was given the Mozobil injection but needed blood in the night and was then told in the morning that he wouldn't be going. His blood count (presumably WBC) was too low and the doc said the myeloma must be coming back. They have started him on Velcade with dex and cyclophosphamide, but we don't know much detail yet.
Does anyone know if it's possible to have stem cells collected after a relapse (presumably) and further chemo?
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
Re: Plasma cell leukaemia stem cell collection failed - help
With the expectation that relapse has occured, then salvage therapy with CyBorD (Cytoxan, Velcade and Dex) is reasonable. We hope that he again responds well. If response is demonstrated, then yes harvesting of stem cells is possible. Especially, with Mozobil. This drug has greatly increased our ability to mobilize stem cells for transplant in myeloma and lymphoma patients. Please ensure that you discuss all of these decisions with your doctor so you can be aware of what and why things are being done.
We hope that salvage works out well.
We hope that salvage works out well.
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Plasma cell leukaemia stem cell collection failed - help
Thanks very much for that, good to know. Will talk to our doc as soon as we get the chance.
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
Re: Plasma cell leukaemia stem cell collection failed - help
Hey Sue-a!
you write:
"I'm so scared that he won't get SCT."
Hope you are not thinking a stem cell transplant is therapy. It's not.
What you are really hoping for is high dose chemotherapy.(HDT).that is the therapy. If you do not agree to that there is no need for a SCT.
HDT is the therapy. SCT is how they treat the adverse effects of HDT. It's salvage NOT therapy.
IOW's the stem cell transplant treats the life-limiting effects of the HDT and you do not need it, unless you submit to those doses of chemotherapy.
Be sure to ask questions about the HDT.
Wishing you and your partner the best with whatever you decide.
you write:
"I'm so scared that he won't get SCT."
Hope you are not thinking a stem cell transplant is therapy. It's not.
What you are really hoping for is high dose chemotherapy.(HDT).that is the therapy. If you do not agree to that there is no need for a SCT.
HDT is the therapy. SCT is how they treat the adverse effects of HDT. It's salvage NOT therapy.
IOW's the stem cell transplant treats the life-limiting effects of the HDT and you do not need it, unless you submit to those doses of chemotherapy.
Be sure to ask questions about the HDT.
Wishing you and your partner the best with whatever you decide.
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Plasma cell leukaemia stem cell collection failed - help
Thanks, yes I do understand that but my concern is that without stem cell collection he won't even have the option of that treatment.
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
Re: Plasma cell leukaemia stem cell collection failed - help
My partner has now had one cycle of Velcade / Dex / Cyclophosphamide. He got a fever / lung infection in the 2nd week and then had an obstruction in his bowel. The consultant (not our normal one, who is away on holiday) has decided that it isn't worth giving him a second cycle of chemo. This is partly because he may not be strong enough (although he has recovered from both 'side effects' and is getting stronger daily), but also because he has some lumps which may be plasmacytomas. So that's it, we just have to wait and let the disease run its course, which apparently may only give us a few more weeks.
I can't believe this is happening, when things were looking reasonably positive only a few weeks back. He isn't that weak, and he isn't ready to give up. I just wish they would let him try another cycle - but maybe other docs think it isn't worth treating him now too?
I can't believe this is happening, when things were looking reasonably positive only a few weeks back. He isn't that weak, and he isn't ready to give up. I just wish they would let him try another cycle - but maybe other docs think it isn't worth treating him now too?
-
sue-a - Name: Sue
- Who do you know with myeloma?: Partner
- When were you/they diagnosed?: Dec 2012
- Age at diagnosis: 59
14 posts
• Page 1 of 2 • 1, 2
Return to Treatments & Side Effects