My husband was diagnosed with multiple myeloma on August 24, 2014, after going to the ER for severe back pain. He has bulging discs already so we thought it was that muscular.
Hospitalized, 3 bone marrow biopsies clear, 3 bone biopsies revealed plasmacytoma on the hip and spine. He started immediately on Revlimid, dex, Zometa, and Velcade.
We found a multiple myeloma specialist in Charlotte, NC, for stem cell transplant, as the local oncologist said he must have it even though the cancer was not in any of his organs. His SPEP as of 3 cycles of the chemo has showed 2/3 cancer killed.
Not sure why the stem cell transplant is still being considered as it doesn't look like it is the recommended treatment for bone plasmacytoma. Blood work has been normal or just above normal from the very beginning.
I questioned both doctors about my confusion. The local oncologist was very defensive yesterday when I stated that the multiple myeloma's office hinted that the stem cell transplant may not be necessary. Any thoughts?
Jill
Forums
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Re: Plasmacytoma - is a transplant necessary?
Jillpra,
Sorry to hear about your husband's situation. I realize all of this can be very confusing.
First, it sounds like your husband was diagnosed with multiple plasmacytomas (hip and spine) due to multiple myeloma. And he also has a monoclonal spike (M-spike) since you said his SPEP showed that "2/3 cancer was killed". So, it really sounds like he has multiple myeloma AND it's clear that his blood work was not "normal" from the beginning, since he at least has an M-spike that has shown up in blood work.
It's not accurate to say that a stem cell transplant wouldn't be one of the correct options to treat this situation. You might be thinking of the situation where a patient is diagnosed with a condition called a "solitary plasmacytoma", where there is a single plasmacytoma with no myeloma cells present in the tumor, as verified through a biopsy. The treatment for a solitary plasmacytoma is usually radiation therapy or some other sort of non-transplant treatment.
But be clear that if you've been diagnosed with multiple myeloma, you can either pursue a stem cell transplant up front, or pursue drug-only treatments with the option to either consider or not consider a transplant down the line.
If you consider a transplant later (let's say when you relapse one or more times while on the drugs), that is called a delayed or salvage transplant/therapy. Of course, you could also choose not to ever do a transplant.
All of these options are quite viable and a good multiple myeloma specialist should be explaining these options to you (although they may have a personal bias to one approach over another). You might want to consider reading this handbook as a starting point.
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
There are then a lot of discussions on this forum regarding the pros and cons of transplants that folks can point you to.
Hope this helps.
Sorry to hear about your husband's situation. I realize all of this can be very confusing.
First, it sounds like your husband was diagnosed with multiple plasmacytomas (hip and spine) due to multiple myeloma. And he also has a monoclonal spike (M-spike) since you said his SPEP showed that "2/3 cancer was killed". So, it really sounds like he has multiple myeloma AND it's clear that his blood work was not "normal" from the beginning, since he at least has an M-spike that has shown up in blood work.
It's not accurate to say that a stem cell transplant wouldn't be one of the correct options to treat this situation. You might be thinking of the situation where a patient is diagnosed with a condition called a "solitary plasmacytoma", where there is a single plasmacytoma with no myeloma cells present in the tumor, as verified through a biopsy. The treatment for a solitary plasmacytoma is usually radiation therapy or some other sort of non-transplant treatment.
But be clear that if you've been diagnosed with multiple myeloma, you can either pursue a stem cell transplant up front, or pursue drug-only treatments with the option to either consider or not consider a transplant down the line.
If you consider a transplant later (let's say when you relapse one or more times while on the drugs), that is called a delayed or salvage transplant/therapy. Of course, you could also choose not to ever do a transplant.
All of these options are quite viable and a good multiple myeloma specialist should be explaining these options to you (although they may have a personal bias to one approach over another). You might want to consider reading this handbook as a starting point.
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
There are then a lot of discussions on this forum regarding the pros and cons of transplants that folks can point you to.
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plasmacytoma - is a transplant necessary?
Hello from sunny (not) Seattle,
In patients with a single (solitary) plasmacytoma, the treatment is radiation alone as long as the bone marrow biopsy and other testing for CRAB do not show symptomatic multiple myeloma.
Patients with two or more plasmacytomas are in a different situation and should have systemic treatment started, as is the case for your husband. The question of a stem cell transplant is not necessarily any different for a patient with myeloma that manifests primarily as plasmacytomas or in a patient with the disease mainly in the marrow (the more common scenario).
A transplant "upfront" – e.g. in the the first 6-12 months of treatment – or at the time the disease first relapses is the standard of care and appropriate treatment. The decision of whether or not to do the transplant early or at first relapse is somewhat subjective and depends on the patient's response to therapy (do the plasmacytomas and M-spike disappear or not) and the transplant oncologist's approach to myeloma as well as patient preference.
I am truly pleased that your husband is getting better and wish for him an excellent response and long remission from his myeloma.
In patients with a single (solitary) plasmacytoma, the treatment is radiation alone as long as the bone marrow biopsy and other testing for CRAB do not show symptomatic multiple myeloma.
Patients with two or more plasmacytomas are in a different situation and should have systemic treatment started, as is the case for your husband. The question of a stem cell transplant is not necessarily any different for a patient with myeloma that manifests primarily as plasmacytomas or in a patient with the disease mainly in the marrow (the more common scenario).
A transplant "upfront" – e.g. in the the first 6-12 months of treatment – or at the time the disease first relapses is the standard of care and appropriate treatment. The decision of whether or not to do the transplant early or at first relapse is somewhat subjective and depends on the patient's response to therapy (do the plasmacytomas and M-spike disappear or not) and the transplant oncologist's approach to myeloma as well as patient preference.
I am truly pleased that your husband is getting better and wish for him an excellent response and long remission from his myeloma.
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
3 posts
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