Good afternoon,
I know there are about 100 different ways to spin an allogeneic transplant these days, but how effective and how difficult is it to get thru a RIC [reduced intensity conditioning] allo, as compared to the other transplants? Any reason why they even do an RIC allo?
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Re: Thoughts on RIC allo stem cell transplants?
I believe Mark and a few others here have done a RIC. After this bump, maybe they’ll chime in. You should start by reviewing the allo transplant-related links in the "Useful links to existing forum discussions" posting in this part of the forum.
Also, I'd recommend Koehne and Giralt paper,
"Allogeneic Hematopoietic Stem Cell Transplantation for Multiple Myeloma: What Place, If Any?", Current Hematologic Malignancy Reports, December 2013 (abstract).
That would hopefully answer the question, why do a RIC.
Good luck.
Also, I'd recommend Koehne and Giralt paper,
"Allogeneic Hematopoietic Stem Cell Transplantation for Multiple Myeloma: What Place, If Any?", Current Hematologic Malignancy Reports, December 2013 (abstract).
That would hopefully answer the question, why do a RIC.
Good luck.
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ivanm - Name: Ivan Mitev
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August, 2011
- Age at diagnosis: 37
Re: Thoughts on RIC allo stem cell transplants?
With the clinical trial at Penn of CAR-T cell auto transplant or a RIC allo as options, does anyone have an opinion of which would be best?
If you do the allo and it doesn't work, can you then do the CAR-T cell? Or vice versa, if you do CAR-T cell can you later do an allo?
Doctor is recommending RIC allo, but we are also interested in exploring CAR-T cell.
If you do the allo and it doesn't work, can you then do the CAR-T cell? Or vice versa, if you do CAR-T cell can you later do an allo?
Doctor is recommending RIC allo, but we are also interested in exploring CAR-T cell.
Re: Thoughts on RIC allo stem cell transplants?
Hello,
I had my RIC allo in May this year after an autoSCT a few months earlier (auto SCT & RIC allo tandem transplant).
The reason a reduced intensity conditioning allo is done is that it is safer than a full allo. Still not as safe as an autologous transplant, though. An allogeneic transplant is known to be curative for some (maybe around 50%, with higher chance of success if done upfront in first CR), but has a high treatment related mortality (~30 to 40%). A RIC allo has risk figures of about 10 to 15%, but is thought to have the same success rate when used in tandem with a autoSCT.
(These are rough stats I remember from when I did my research on allo last year, I may be wrong.)
In general, the RIC allo is a lot easier than the auto SCT, as the bone marrow is not fully destroyed and you don't have the horrible high dose melphalan. But it takes a long time for the donor bone marrow and immune system to establish, so the feeling of tiredness lasts longer.
For me, my auto SCT went well and I just had a few bad days with the usual sore mouth and throat, and throwing up for a few days. I recovered quite quickly afterwards with no ongoing issues.
The initial conditioning treatment for RIC allo was a lot easier than my auto. I was able to get about the hospital and walk outside the whole 2 weeks I was in.
I decided to do an auto SCT & RIC allo tandem as an upfront treatment in my first CR to give me the best currently available chance of cure. If not cure, then there is a good chance of having a long drug free remission, therefore good quality of life. Of course, the risks are real even with the reduced intensity conditioning. A higher percentage of allo patients relapse in the first year compared with auto patients. And risk of getting cGvHD needs to be consider too, which can range from quite mild to life changing.
Sorry, I don't know anything about the 'CAR T cell auto'.
Laura
I had my RIC allo in May this year after an autoSCT a few months earlier (auto SCT & RIC allo tandem transplant).
The reason a reduced intensity conditioning allo is done is that it is safer than a full allo. Still not as safe as an autologous transplant, though. An allogeneic transplant is known to be curative for some (maybe around 50%, with higher chance of success if done upfront in first CR), but has a high treatment related mortality (~30 to 40%). A RIC allo has risk figures of about 10 to 15%, but is thought to have the same success rate when used in tandem with a autoSCT.
(These are rough stats I remember from when I did my research on allo last year, I may be wrong.)
In general, the RIC allo is a lot easier than the auto SCT, as the bone marrow is not fully destroyed and you don't have the horrible high dose melphalan. But it takes a long time for the donor bone marrow and immune system to establish, so the feeling of tiredness lasts longer.
For me, my auto SCT went well and I just had a few bad days with the usual sore mouth and throat, and throwing up for a few days. I recovered quite quickly afterwards with no ongoing issues.
The initial conditioning treatment for RIC allo was a lot easier than my auto. I was able to get about the hospital and walk outside the whole 2 weeks I was in.
I decided to do an auto SCT & RIC allo tandem as an upfront treatment in my first CR to give me the best currently available chance of cure. If not cure, then there is a good chance of having a long drug free remission, therefore good quality of life. Of course, the risks are real even with the reduced intensity conditioning. A higher percentage of allo patients relapse in the first year compared with auto patients. And risk of getting cGvHD needs to be consider too, which can range from quite mild to life changing.
Sorry, I don't know anything about the 'CAR T cell auto'.
Laura
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LauraScot - Name: Laura
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2013
- Age at diagnosis: 47
Re: Thoughts on RIC allo stem cell transplants?
Hi Terrij,
First off, I hope things turn around for your daughter. I can relate in the sense that both of my parents are still alive and I know it was really tough on them when I was going through treatment. "Knock on wood", I am doing great since my allo and I currently live like a "normal" person who is in their mid 40's. I have been very fortunate. I am going to be writing a nice Thanksgiving message to my donor as soon as I am done writing this post. I could never thank her enough for what she did for me and my family.
Laura gave a great post with respect to allo transplants. If you read my other posts you will see that I am constantly writing that an allo is ideally done in first complete response. The chance of an allo being curative is much lower if done after a patient has relapsed, and even less if they have active disease. Having said that, there are some success stories of allos done on relapsed myeloma patients. Well known myeloma patient advocate Jack Aiello has been in remission for 20 years and he did his allo after relapsing off tandem autos.
It is difficult to discuss anti CD19 CAR T cells for myeloma patients since there is no published data on it. The cancer that anti CD19 CAR T cells have had the most success has been for ALL (acute lymphoblastic leukemia). What seems to show the most promise is using the anti CD19 CART cells to get the relapsed ALL patients into remission and then immediately doing an allo transplant to maintain the remission.
"According to the most recent data Exit Disclaimer from a POB trial that included children with ALL, 14 of 20 patients had a complete response. And of the 12 patients who had no evidence of leukemic cells, called blasts, in their bone marrow after CAR T-cell treatment, 10 have gone on to receive a stem cell transplant and remain cancer free, reported the study’s lead investigator, Daniel W. Lee, M.D., also of the POB.
“Our findings strongly suggest that CAR T-cell therapy is a useful bridge to bone marrow transplant for patients who are no longer responding to chemotherapy,” Dr. Lee said.
Similar results have been seen in phase I trials of adult patients conducted at MSKCC and NCI.
In findings published in February 2014, 14 of the 16 participants in the MSKCC trial treated to that point had experienced complete responses, which in some cases occurred 2 weeks or sooner after treatment began. Of those patients who were eligible, 7 underwent a stem cell transplant and are still cancer free."
http://www.cancer.gov/cancertopics/research-updates/2013/CAR-T-Cells
No one has any idea if they will be able to get myeloma patients into remission like they do with ALL. Also I do not think your daughter would qualify for the UPenn study. One of the study requirements is: "Subjects must have undergone a prior ASCT for multiple myeloma and have progressed within 365 days of stem cell infusion."
"CART-19 for Multiple Myeloma," clinical trial description at clinicaltrials.gov
From your previous posts I believe you said your daughter was in remission for longer than a year. Dr. Jan Stafl who posts here on the Beacon is a patient and he mentioned he was receiving CAR T cells at UPenn recently. Hopefully he will post soon with some good news of him being in remission!
Here is another CAR T cell trial at the NIH for myeloma. This one has a different target - B cell maturation antigen (BCMA):
"Study of T Cells Targeting B-Cell Maturation Antigen for Previously Treated Multiple Myeloma," clinical trial information at clinicaltrials.Gov.
Here is a link to a thread where I have been putting some links to articles about CAR T cells since I know a lot of patients here are interested in reading about them:
"Immunotherapy - CAR T cells", Beacon forum thread started April 7, 2014.
Good luck to your daughter moving forward!
Mark
First off, I hope things turn around for your daughter. I can relate in the sense that both of my parents are still alive and I know it was really tough on them when I was going through treatment. "Knock on wood", I am doing great since my allo and I currently live like a "normal" person who is in their mid 40's. I have been very fortunate. I am going to be writing a nice Thanksgiving message to my donor as soon as I am done writing this post. I could never thank her enough for what she did for me and my family.
Laura gave a great post with respect to allo transplants. If you read my other posts you will see that I am constantly writing that an allo is ideally done in first complete response. The chance of an allo being curative is much lower if done after a patient has relapsed, and even less if they have active disease. Having said that, there are some success stories of allos done on relapsed myeloma patients. Well known myeloma patient advocate Jack Aiello has been in remission for 20 years and he did his allo after relapsing off tandem autos.
It is difficult to discuss anti CD19 CAR T cells for myeloma patients since there is no published data on it. The cancer that anti CD19 CAR T cells have had the most success has been for ALL (acute lymphoblastic leukemia). What seems to show the most promise is using the anti CD19 CART cells to get the relapsed ALL patients into remission and then immediately doing an allo transplant to maintain the remission.
"According to the most recent data Exit Disclaimer from a POB trial that included children with ALL, 14 of 20 patients had a complete response. And of the 12 patients who had no evidence of leukemic cells, called blasts, in their bone marrow after CAR T-cell treatment, 10 have gone on to receive a stem cell transplant and remain cancer free, reported the study’s lead investigator, Daniel W. Lee, M.D., also of the POB.
“Our findings strongly suggest that CAR T-cell therapy is a useful bridge to bone marrow transplant for patients who are no longer responding to chemotherapy,” Dr. Lee said.
Similar results have been seen in phase I trials of adult patients conducted at MSKCC and NCI.
In findings published in February 2014, 14 of the 16 participants in the MSKCC trial treated to that point had experienced complete responses, which in some cases occurred 2 weeks or sooner after treatment began. Of those patients who were eligible, 7 underwent a stem cell transplant and are still cancer free."
http://www.cancer.gov/cancertopics/research-updates/2013/CAR-T-Cells
No one has any idea if they will be able to get myeloma patients into remission like they do with ALL. Also I do not think your daughter would qualify for the UPenn study. One of the study requirements is: "Subjects must have undergone a prior ASCT for multiple myeloma and have progressed within 365 days of stem cell infusion."
"CART-19 for Multiple Myeloma," clinical trial description at clinicaltrials.gov
From your previous posts I believe you said your daughter was in remission for longer than a year. Dr. Jan Stafl who posts here on the Beacon is a patient and he mentioned he was receiving CAR T cells at UPenn recently. Hopefully he will post soon with some good news of him being in remission!
Here is another CAR T cell trial at the NIH for myeloma. This one has a different target - B cell maturation antigen (BCMA):
"Study of T Cells Targeting B-Cell Maturation Antigen for Previously Treated Multiple Myeloma," clinical trial information at clinicaltrials.Gov.
Here is a link to a thread where I have been putting some links to articles about CAR T cells since I know a lot of patients here are interested in reading about them:
"Immunotherapy - CAR T cells", Beacon forum thread started April 7, 2014.
Good luck to your daughter moving forward!
Mark
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Mark11
Re: Thoughts on RIC allo stem cell transplants?
Thank you Mark. You are so well informed. All the information out there is overwhelming. So many of the things for myeloma seem experimental for those who have relapsed. As her mother, I am still reaching for things to "cure", or at least let our daughter be in remission for a long time.
She has had a hard time. After doing DCEP treatment a couple of weeks ago, she ended up back in the hospital due to neutropenia and with C diff. She will be getting out tomorrow just in time for Thanksgiving.
I have heard that Penn has done CAR T cell with 4 myeloma patients, but don't know the specifics. She will probably go with the allo transplant with her brother as donor.
I read the forum on the Beacon because people like yourself are so knowledgeable. It helps a lot. Thank you.
She has had a hard time. After doing DCEP treatment a couple of weeks ago, she ended up back in the hospital due to neutropenia and with C diff. She will be getting out tomorrow just in time for Thanksgiving.
I have heard that Penn has done CAR T cell with 4 myeloma patients, but don't know the specifics. She will probably go with the allo transplant with her brother as donor.
I read the forum on the Beacon because people like yourself are so knowledgeable. It helps a lot. Thank you.
Re: Thoughts on RIC allo stem cell transplants?
So how much safer is the RIC usually compared to a full blown allo? Also, is a RIC curable?
I am in my first relapse, but it is very slow. If the RIC works best in the first remission, why are they contemplating doing this transplant?
I am in my first relapse, but it is very slow. If the RIC works best in the first remission, why are they contemplating doing this transplant?
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Guest1
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