[rmcarch]

Residual Disease before stem cell transplantation

by rmcarch on Thu Aug 04, 2011 1:26 am

Hello all,
I have a completely theoretical layman's question regarding yesterday's stimulating News post "Residual Disease before Stem Cell Transplantation may predict Survival in Multiple Myeloma Patients".

If the goal of therapy prior to Autologous Stem Cell Transplant became the achievement of a low level of residual disease, could patients whose response improves after stem cell harvest and during an interval of following maintenance therapy also improve their survivability pre ASCT by undergoing a second stem cell harvest in order to collect less contaminated stem cells?

I am looking for a qualified theoretical response disregarding insurance issues (for example), other pragmatic issues and recognizing that continued treatment reduces stem cell harvest amounts but also that some patients easily mobilize and achieve post induction therapy harvest quotas on the first day of harvest.

[Dr. Edward Libby]

Re: Residual Disease before stem cell transplantation

by Dr. Edward Libby on Thu Aug 04, 2011 5:38 pm

Good question. Potentially this could work but it would mean extra chemotherapy/GCSF for the 2nd mobilization with all of the attendant risks and side effects. In addition the stem cell collection process itself has risks and is very expensive. Two separate stem cell collections would be more expensive than one. Finally, it is not clear that the level of residual disease has major impact on the disease free survival of patients receiving an autologous transplant for myeloma. The study cited is interesting but the patient numbers are tiny. It is hoped that in the future that we could use the level of residual disease to determine what therapies should be used next AND when or if transplant is indicated. Perhaps the level of residual disease could be used to help some patients without residual disease achieve new levels of disease free survival......possibly even the elusive cure. Without question this is an important area of myeloma resarch.