[orchid]

Are there situations when SCT should be done ASAP?

by orchid on Tue Jul 08, 2014 6:18 am

After 4 cycles induction with CyBorD, my brother's multiple myeloma was controlled from an M-spike of 33 g/L (3.3 g/dL) down to 3.1 g/L.

[CyBorD = cyclophosphamide (Cytoxan) + Velcade (bortezomib) + dexamethasone]

Induction was stopped to start for the stem cell transplant [SCT]. Stem cells have not been collected yet.

3 weeks after stopping the induction, the disease numbers started to climb, the doctor suggested to start new treatment with Revlimid to control the disease again and to monitor the situation again very closely before moving to the next step of stem cell transplantation. New medication is used because, between the last 2 cycles of CyBorD, numbers of IgA and FLC lambda started to climb. This, according to the doctor, made my brother already refractory to Velcade (part of the CyBorD regimen).

Very soon after this, emergencies occurred for new pain in the spine of my brothers. He was hospitalized 2 times (within 3 weeks) for radiotherapy and dex to alleviate the 2 different local spine problems of extreme pain (epidural tumor was found with cord compression) .

Giving this huge complication of the spine problems and that a new one might occur, the doctor ordered to stop Revlimid and start the process of collecting stem cells to move as quickly as possible to SCT as the fastest way to control the disease and by that reduce potential problems on the spine and that we go later on other regimens to continue treating the disease maybe another SCT in play.

Revlimid was stopped because it inhibits stem cell collecting

M-spike currently hovers around 17 g/L (1.7 g/dL).

Before mobilization, a huge dose of cyclophosphamide was given before starting the Neupogen injection.

Stem cells still not collected but should start in the coming days.

Question: Are there exceptional situations where a stem cell transplant should be performed as soon as possible, as the doctor is suggesting? Would the situation of my brother with epidural tumor in the spine and the fear that it might continue to other places in spine be considered such an exception.

According to the doctor, with Revlimid controlling the disease, it will take time, and since we do not have stem cell collected, an SCT will not be possible and also the complication of the spine

Thanks for the community's opinion in advance

[Multibilly]

Re: Are there situations when SCT should be done ASAP?

by Multibilly on Thu Jul 10, 2014 10:56 am

If you have made the decision to go with a transplant, I recall that there is emerging information out there that the transplant will be more successful if you achieve a deeper response prior to the transplant. If I were to do a transplant, I would personally be looking for a better response level prior to doing the HD melphalan for the transplant.

I also realize that you've got several extenuating circumstances going on here, so I will acknowledge that may put a different spin on things.

In any case, I might respectfully suggest a second opinion from another multiple myeloma specialist before proceeding.

Last edited by Multibilly on Thu Jul 10, 2014 11:35 am, edited 1 time in total.

[Nancy Shamanna]

Re: Are there situations when SCT should be done ASAP?

by Nancy Shamanna on Thu Jul 10, 2014 11:33 am

Hi Orchid, I am sorry that your brother is still having such a lot of problems with his myeloma. It sounds as if the doctors at your cancer centre are doing everything that they can to try to help him though.

It does take some time to get the stem cells collected, as you have noted, and that is the important thing as far as the possibility of an SCT. Once the stem cells are harvested, they can be stored for five years or more.

Wishing you all the best, and please keep us posted as to how your brother is doing.

[orchid]

Re: Are there situations when SCT should be done ASAP?

by orchid on Fri Jul 11, 2014 6:34 am

Thanks both