Hello, everyone:
My sister is currently preparing for her autologous stem cell transplant and when we talked this morning, she said something that I never thought about and now would like to understand better.
She thinks that the transplant is used to regain the blood health following aggressive high dose chemo, and it's the chemo that kills cancer and not the transplant. The chemo is so strong and it causes such a damage that a transplant is needed to survive. So the plan is to use a killer chemo to eliminate the cancer and then to do a transplant to keep the person alive / repair the damage.
I am not sure if I am making any sense, but when my sister said that, it made sense to me, though I am not sure it is a correct conclusion as my previous understanding was different.
So, this is what I want to understand: Is the transplant itself doing something against the cancer, or is it the high dose chemo that fights the cancer and then the transplant repairs the damage?
I know that many of you are very well informed about the science behind the treatments and I'd be thankful for any clarification.
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Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
Re: Purpose of an autologous stem cell transplant?
Hi Gala,
Your sister is correct. The purpose of putting the patient's stem cells back after an autologous transplant is to aid in the patient's recovery. The high-dose chemo is the therapy.
That is in contrast to an allogeneic transplant (like Robin Roberts did), where the donor immune system is the important part of the therapy. A healthy functioning donor immune system can recognize the cancer as foreign and kill it. A patient's own immune system does not recognize the cancer as foreign and therefore does not kill it. An allogeneic transplant is considered immunotherapy while an autologous transplant is not. That is why you see allogeneic transplant recipients (like me!) giving their donor credit for helping save their life.
Does that clear it up for you?
Mark
Your sister is correct. The purpose of putting the patient's stem cells back after an autologous transplant is to aid in the patient's recovery. The high-dose chemo is the therapy.
That is in contrast to an allogeneic transplant (like Robin Roberts did), where the donor immune system is the important part of the therapy. A healthy functioning donor immune system can recognize the cancer as foreign and kill it. A patient's own immune system does not recognize the cancer as foreign and therefore does not kill it. An allogeneic transplant is considered immunotherapy while an autologous transplant is not. That is why you see allogeneic transplant recipients (like me!) giving their donor credit for helping save their life.
Does that clear it up for you?
Mark
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Mark11
Re: Purpose of an autologous stem cell transplant?
Hi Gala,
Let me try to add a bit more color to Mark's comments.
You start with that is known as induction therapy with various drugs to help knock down the myeloma in the body as much as possible. This is also often the same drug regimen that folks initiating treatment without a planned transplant would use and is not to be confused with the high dose chemo that is to follow later.
You then harvest stem cells from the person's blood.
You then begin the high dose chemo to wipe out the cancer cells, but also the bone marrow. This is really the treatment phase. You then inject the previously harvested stem cells back into one's blood stream and all the various blood cell types that were wiped out before are then rebuilt from these stem cells. Once the new blood cells and bone marrow forms, your immune system is then reconstituted from these new blood cells...hopefully devoid of any cancer.
Unfortunately, an autologous stem cell transplant doesn't always work or the cancer will re-emerge at a later time. This is either because not all the cancer cells were wiped out by the high dose chemo, or because there are still "progenitor" cells lurking in one's body that can generate new myeloma cells over time. And even though you have a newly reconstituted immune system after the transplant, it is still basically the same the same old immune system that was incapable of successfully fighting off the myeloma cancer in the first place.
Mark is doing well because he had an allo transplant and the donor's foreign immune system is better able to recognize any of his cancer cells and deal with that cancer. But his procedure is a more risky path, has its own challenges and also requires a well-matched donor.
Let me try to add a bit more color to Mark's comments.
You start with that is known as induction therapy with various drugs to help knock down the myeloma in the body as much as possible. This is also often the same drug regimen that folks initiating treatment without a planned transplant would use and is not to be confused with the high dose chemo that is to follow later.
You then harvest stem cells from the person's blood.
You then begin the high dose chemo to wipe out the cancer cells, but also the bone marrow. This is really the treatment phase. You then inject the previously harvested stem cells back into one's blood stream and all the various blood cell types that were wiped out before are then rebuilt from these stem cells. Once the new blood cells and bone marrow forms, your immune system is then reconstituted from these new blood cells...hopefully devoid of any cancer.
Unfortunately, an autologous stem cell transplant doesn't always work or the cancer will re-emerge at a later time. This is either because not all the cancer cells were wiped out by the high dose chemo, or because there are still "progenitor" cells lurking in one's body that can generate new myeloma cells over time. And even though you have a newly reconstituted immune system after the transplant, it is still basically the same the same old immune system that was incapable of successfully fighting off the myeloma cancer in the first place.
Mark is doing well because he had an allo transplant and the donor's foreign immune system is better able to recognize any of his cancer cells and deal with that cancer. But his procedure is a more risky path, has its own challenges and also requires a well-matched donor.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Purpose of an autologous stem cell transplant?
My take is a bit different. I think the autologous stem cell transplant works as part of an integrated package. I firmly believe the transplant gave me a fresher start and has extended my life.
Mine was 5 years ago this month, and I'm now relapsed at a low number and quite manageable.
My understanding of the process was Velcade and dexamethasone treatment followed by higher dose Velcade and dexamethasone once confirmed as a candidate for transplant.
I am making these following comments from the info gathered by a patient who keeps a close eye on my doctors. Please verify.
The personal stem cells for some reason are not cancerous. Once the transplant is completed, I remained at a low number with a significant partial response (PR). I went into the transplant in a similar status but higher numbers.
The transplant process involves extreme chemo to kill the bone marrow, not to be confused with high-dose ongoing treatment. This killing of the marrow is critical to success of both transplant. The autologous stem cell transplant does not involve graft versus host complications seen in allogeneic (donor) transplants. I sure think of the allogeneic group often for their courage and persistence.
I might add that if your sister has a working concept of the physical process, let her run with it. It is an incredible time of stress for the patient and their loving family. In my opinion, she is in good hands and, if a candidate, it is very positive therapeutical direction.
God bless.
Mine was 5 years ago this month, and I'm now relapsed at a low number and quite manageable.
My understanding of the process was Velcade and dexamethasone treatment followed by higher dose Velcade and dexamethasone once confirmed as a candidate for transplant.
I am making these following comments from the info gathered by a patient who keeps a close eye on my doctors. Please verify.
The personal stem cells for some reason are not cancerous. Once the transplant is completed, I remained at a low number with a significant partial response (PR). I went into the transplant in a similar status but higher numbers.
The transplant process involves extreme chemo to kill the bone marrow, not to be confused with high-dose ongoing treatment. This killing of the marrow is critical to success of both transplant. The autologous stem cell transplant does not involve graft versus host complications seen in allogeneic (donor) transplants. I sure think of the allogeneic group often for their courage and persistence.
I might add that if your sister has a working concept of the physical process, let her run with it. It is an incredible time of stress for the patient and their loving family. In my opinion, she is in good hands and, if a candidate, it is very positive therapeutical direction.
God bless.
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Canuck Bob - Name: Bob
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb. 2011
- Age at diagnosis: 57
Re: Purpose of an autologous stem cell transplant?
Hi Canuck Bob,
Congratulations on a 5-year remission. I also noticed your thread about your participation in a Selinexor clinical trial. Thanks for contributing to what will hopefully be a new therapy for all myeloma patients.
You wrote:
I think you and I are pretty much in agreement on most everything you posted. Autologous transplants do increase overall survival for myeloma patients. High dose melphalan is the myeloma drug with the most single agent activity. I had two high doses of melphalan back in 2011 and I currently enjoy an excellent quality of life and I am now coming up on 5 and a half years of drug-free remission. High dose melphalan was a key part of my therapy and you said it exactly right - it is a part of an integrated package. Any therapy that helps myeloma patients as much as it helped the two of us and many others gets "two thumbs way up" from me.
You also wrote:
I agree with that for the most part. I actually consider graft-versus-host-disease (GVHD) to be a positive "side effect" in that having a small amount of it is ideal as it does not negatively impact quality of life much and having it means that the patient is less likely to relapse. To give you an idea, I had limited chronic GVHD for one month back in early 2012 (sore gums and skin rash). It has gone away with no therapy and has never returned. I think it is safe to say that is much less side effects than patients that are on continuous therapy have to endure and it is much less likely that I will ever relapse than most patients. Those are very limited side effects given all the benefits of the donor immune system. I was able to do my allo in a way that minimized my chances of having GVHD thanks to my induction and the autologous transplant getting me to complete response (CR) prior to my doing the allogeneic transplant.
Best wishes for continued success with your therapies.
Mark
Congratulations on a 5-year remission. I also noticed your thread about your participation in a Selinexor clinical trial. Thanks for contributing to what will hopefully be a new therapy for all myeloma patients.
You wrote:
My take is a bit different. I think the autologous stem cell transplant works as part of an integrated package. I firmly believe the transplant gave me a fresher start and has extended my life.
I think you and I are pretty much in agreement on most everything you posted. Autologous transplants do increase overall survival for myeloma patients. High dose melphalan is the myeloma drug with the most single agent activity. I had two high doses of melphalan back in 2011 and I currently enjoy an excellent quality of life and I am now coming up on 5 and a half years of drug-free remission. High dose melphalan was a key part of my therapy and you said it exactly right - it is a part of an integrated package. Any therapy that helps myeloma patients as much as it helped the two of us and many others gets "two thumbs way up" from me.
You also wrote:
The transplant process involves extreme chemo to kill the bone marrow, not to be confused with high-dose ongoing treatment. This killing of the marrow is critical to success of both transplant. The autologous stem cell transplant does not involve graft versus host complications seen in allogeneic (donor) transplants. I sure think of the allogeneic group often for their courage and persistence.
I agree with that for the most part. I actually consider graft-versus-host-disease (GVHD) to be a positive "side effect" in that having a small amount of it is ideal as it does not negatively impact quality of life much and having it means that the patient is less likely to relapse. To give you an idea, I had limited chronic GVHD for one month back in early 2012 (sore gums and skin rash). It has gone away with no therapy and has never returned. I think it is safe to say that is much less side effects than patients that are on continuous therapy have to endure and it is much less likely that I will ever relapse than most patients. Those are very limited side effects given all the benefits of the donor immune system. I was able to do my allo in a way that minimized my chances of having GVHD thanks to my induction and the autologous transplant getting me to complete response (CR) prior to my doing the allogeneic transplant.
Best wishes for continued success with your therapies.
Mark
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Mark11
Re: Purpose of an autologous stem cell transplant?
Thanks for a new understanding of host versus graft disease (GVHD). Very welcome.
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Canuck Bob - Name: Bob
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb. 2011
- Age at diagnosis: 57
Re: Purpose of an autologous stem cell transplant?
Mark11, Bob, and Multibilly - Thank you so much for your input. I have a much better understanding now of the purpose of a transplant.
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Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
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