Plasma cell leukemia (PCL) with refractory / relapsed multiple myeloma can be a real challenge to treat. See this recent case study outlining a new treatment approach for dealing with this combination of diseases:
Case Study: WT1-Specific T-Cell Responses in a Patient with Plasma Cell Leukemia and Relapsed Refractory Multiple Myeloma
(If you can't see the video directly above, it's also available at this page at the Memorial Sloan-Kettering website.)
Forums
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plasma cell leukemia in relapsed myeloma - case study
Thanks so much for posting that. There are so many promising treatments on the horizon, it's almost difficult to keep track of them all! Isn't that wonderful?
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Plasma cell leukemia in relapsed myeloma - case study
This is definitely an approach with great promise, in my opinion. I did a partially T cell depleted allo and my experience with it has been very positive. I wrote a long post discussing T cell depleted allos and used an example of combining it with CAR T cells in ALL (acute lymphocytic leukemia) back in February of 2014. Here is a link for those bored enough to want to read it!
"T cell depleted transplants and immunotherapy," Beacon forum discussion started Feb 20, 2014
Has anyone heard from IvanM? He has not posted for a while. I hope he is doing well.
"T cell depleted transplants and immunotherapy," Beacon forum discussion started Feb 20, 2014
Has anyone heard from IvanM? He has not posted for a while. I hope he is doing well.
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Mark11
Re: Plasma cell leukemia in relapsed myeloma - case study
Would the donor for this have to be a full match or could they be a half match? Our son is a half match for our daughter.
Re: Plasma cell leukemia in relapsed myeloma - case study
Many of you know that I am trying to pursue an allogeneic stem cell transplant, where the stem cells come from someone else - a donor. Many of you also know that I am having a difficult time finding a matching donor. There is one woman who is a 7/8 match, but she is unavailable to finish her testing until Nov 1. At that time, she will be approached again and asked if she would be willing to finish her testing to see if she is truly eligible. I have no idea how this will turn out - she may decline, or it may turn out that she is ineligible for some reason, or she may be perfect.
Anyway, I've decided that if it doesn't work out for that potential donor, and I still have no match by November, I'm going to get a second opinion at U Penn. I'm going to start chasing some other treatment possibilities. These emerging T cell therapies are right at the top of my list. I figure by that time, I gave allo transplant enough of a shot and I waited long enough.
So I'm watching the T cell news very carefully. All these developments are really exciting.
Anyway, I've decided that if it doesn't work out for that potential donor, and I still have no match by November, I'm going to get a second opinion at U Penn. I'm going to start chasing some other treatment possibilities. These emerging T cell therapies are right at the top of my list. I figure by that time, I gave allo transplant enough of a shot and I waited long enough.
So I'm watching the T cell news very carefully. All these developments are really exciting.
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Plasma cell leukemia in relapsed myeloma - case study
Tracy-
Why wait until November to possibly get a second opinion at Penn? It can't hurt to do it sooner and then you would know if this is a likely possibility for you, or not. If it is a possibility, there is a lot of pretesting, etc, that needs to be done before being accepted into the clinical trial and then prior to actually having the procedure. By getting an opinion prior to November, you would have that answer already in your pocket if the allo route doesn't turn up a good match and a willing donor.
BradStrong, who writes a blog, was supposed to have the procedure in January, but some technical issues made it so it had to be cancelled. He did go ahead and have the auto transplant again because he had relapsed from the first auto so quickly, less than one year. He may be considered for the T-cell procedure again.
I hope that you find the allo match that you need and/or you qualify for the T-cell procedure. If both become possible, you have a really tough decision to make as to which to do.
All the best to you,
Nancy in Phila
Why wait until November to possibly get a second opinion at Penn? It can't hurt to do it sooner and then you would know if this is a likely possibility for you, or not. If it is a possibility, there is a lot of pretesting, etc, that needs to be done before being accepted into the clinical trial and then prior to actually having the procedure. By getting an opinion prior to November, you would have that answer already in your pocket if the allo route doesn't turn up a good match and a willing donor.
BradStrong, who writes a blog, was supposed to have the procedure in January, but some technical issues made it so it had to be cancelled. He did go ahead and have the auto transplant again because he had relapsed from the first auto so quickly, less than one year. He may be considered for the T-cell procedure again.
I hope that you find the allo match that you need and/or you qualify for the T-cell procedure. If both become possible, you have a really tough decision to make as to which to do.
All the best to you,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Plasma cell leukemia in relapsed myeloma - case study
Just to add on to the discussion, I would also look into this CAR T cell trial targeting BCMA at the NIH if I was ineligible for allo transplant:
"Study of T Cells Targeting B-Cell Maturation Antigen for Previously Treated Multiple Myeloma" (clinical trial information at clinicaltrials.gov)
There is no agreement on what the optimal target is for myeloma. Evidence is sparse on what might be a good target for myeloma. Note this paper can only find 2 human examples of success to show that BCMA may be a good target.
"Study of T Cells Targeting B-Cell Maturation Antigen for Previously Treated Multiple Myeloma" (clinical trial information at clinicaltrials.gov)
There is no agreement on what the optimal target is for myeloma. Evidence is sparse on what might be a good target for myeloma. Note this paper can only find 2 human examples of success to show that BCMA may be a good target.
Evidence that BCMA might be a target for anti-myeloma immunity in humans has been reported (28). Allogeneic stem cell transplantation (AlloSCT) is sometimes used to treat multiple myeloma (4). In patients with relapsed or persistent multiple myeloma after AlloSCT, infusions of unmanipulated allogeneic lymphocytes from the original transplant donor can sometimes induce complete remissions (4, 28). Two patients who obtained complete remissions of relapsed multiple myeloma after infusions of allogeneic donor lymphocytes developed serum anti-BCMA antibodies only after the donor lymphocyte infusions (28). The serum of both of these patients killed BCMA-expressing target cells in vitro by complement-mediated lysis and antibody-dependent cellular cytotoxicity (28)."
Source: RO Carpenter et al, "B-cell Maturation Antigen Is a Promising Target for Adoptive T-cell Therapy of Multiple Myeloma," Clinical Cancer Research, April 15, 2013 (link to full text of article)
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Mark11
Re: Plasma cell leukemia in relapsed myeloma - case study
Tracy,
I agree with Nancy in the fact that you should go talk to Penn now. To be eligible for the CAR T cell auto transplant they do now, you have to have relapsed within a year of your first transplant. My daughter was 15 months, so she was not eligible, but we have been told they will be opening up other T cell trials in the fall.
My son is a half match for his sister. Johns Hopkins and Thomas Jefferson in Philly do half match allo transplants, which they say work just as well. One thing is that, if you have an allo transplant, it makes you ineligible for T cell.
It's a lot to think about to try and make the best decision. My daughter will probably be deciding in the fall what the next step is once her numbers are in remission.
Good luck.
I agree with Nancy in the fact that you should go talk to Penn now. To be eligible for the CAR T cell auto transplant they do now, you have to have relapsed within a year of your first transplant. My daughter was 15 months, so she was not eligible, but we have been told they will be opening up other T cell trials in the fall.
My son is a half match for his sister. Johns Hopkins and Thomas Jefferson in Philly do half match allo transplants, which they say work just as well. One thing is that, if you have an allo transplant, it makes you ineligible for T cell.
It's a lot to think about to try and make the best decision. My daughter will probably be deciding in the fall what the next step is once her numbers are in remission.
Good luck.
Re: Plasma cell leukemia in relapsed myeloma - case study
Yes, the more I think about it, the more I think I will go to Penn sooner rather than later. Now I'm thinking about early this summer, instead of waiting until November. I was sort of hoping to wait for the myeloma target to be figured out a little better, but we'll see.
You all know, this is a rolling process with many decision points, where the decision determines the downstream options. At some point, it doesn't pay to spend extreme amounts of energy thinking about ALL the downstream options, because many (if not most) will never come into your field of play
But it's difficult to not obsess.
You all know, this is a rolling process with many decision points, where the decision determines the downstream options. At some point, it doesn't pay to spend extreme amounts of energy thinking about ALL the downstream options, because many (if not most) will never come into your field of play
But it's difficult to not obsess.
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Plasma cell leukemia in relapsed myeloma - case study
Hi all,
Just checking if anybody has more info on the above case study.
Also any other people with any recent experience with this condition?
My mum has been diagnosed with the same after a relapsed myeloma. Any further update information would be super helpful!
Just checking if anybody has more info on the above case study.
Also any other people with any recent experience with this condition?
My mum has been diagnosed with the same after a relapsed myeloma. Any further update information would be super helpful!
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