I was supposed to harvest my stem cells tomorrow, but I had a completely dismal response to the Neupogen / Zarxio. The on call doctor said that I didn't even have hardly any spike in my white count or the CD34 number.
Overall, I am healthy. I have only been on Revlimid, Velcade, and dexamethasone (RVD) for 5 cycles. I did have the highest dosage and I started out with a lot of disease.
Does it it happen often that someone gets to the day before collection and then has the collection cancelled and gets sent home?
The doctors and nurses seemed to be pretty surprised. I am not sure what to make of it. I have tried to google and look for some articles, but haven't found anything on that front either.
Thanks.
Forums
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• Page 1 of 1
Re: Stem cell collection canceled
This happened to me in November 2017. I had done all the pre-testing for transplant, moved across the street from the cancer center, and was ready to go. But after four days of testing my levels, they told me I hadn't responded and I should have my apheresis catheter removed and go home. It was devastating, but I have since mentally adjusted (mostly).
My specialist told me I was only the second patient he had seen fail to mobilize during his two years at the center. I was expecting them to try Mozobil (plerixafor), but the head of the program didn't think it would be helpful in my case. I am already in complete response, so they put me on 10 mg Revlimid for maintenance.
Hang in there!
My specialist told me I was only the second patient he had seen fail to mobilize during his two years at the center. I was expecting them to try Mozobil (plerixafor), but the head of the program didn't think it would be helpful in my case. I am already in complete response, so they put me on 10 mg Revlimid for maintenance.
Hang in there!
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LindaM - Name: Linda
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2016
- Age at diagnosis: 59
Re: Stem cell collection canceled
Hi BMyers,
Sorry to hear about what happened with your stem cell collection. I think what you experienced is rather rare. I don't have exact statistics in front of me, but my recollection from doing some reading on the subject is that a bit over 90 percent of myeloma patients going in for stem cell collection are able to collect enough with just Neupogen (or Cytoxan) mobilization, and another 5 percent or so can collect enough with an extra "push" from Mozobil. I suspect only one or two out of every 100 stem cell collection candidates who have myeloma find themselves in a situation like yours.
If you and your doctors really want to go forward with the collection and transplant, maybe you can come up with a strategy involving, say, a treatment holiday and then multiple drugs for mobilization that will get your CD34 counts up high enough for mobilization.
In case you're interested, there have been a few threads here in the forum that were started by people who were not able to collect enough stem cells. Maybe some of the threads will have useful ideas that you and your doctors can consider:
"Stem cell collection failed" (started Dec 25, 2014)
"Stem cell harvest failed - should I stress?" (started Jan 23, 2015)
"Difficulty harvesting stem cells" (started Dec 16, 2010)
If you want to review all stem cell collection discussions in the forum, this link (which is the result of an "advanced" search using the forum search box) should pull up just about all of them.
Good luck!
Sorry to hear about what happened with your stem cell collection. I think what you experienced is rather rare. I don't have exact statistics in front of me, but my recollection from doing some reading on the subject is that a bit over 90 percent of myeloma patients going in for stem cell collection are able to collect enough with just Neupogen (or Cytoxan) mobilization, and another 5 percent or so can collect enough with an extra "push" from Mozobil. I suspect only one or two out of every 100 stem cell collection candidates who have myeloma find themselves in a situation like yours.
If you and your doctors really want to go forward with the collection and transplant, maybe you can come up with a strategy involving, say, a treatment holiday and then multiple drugs for mobilization that will get your CD34 counts up high enough for mobilization.
In case you're interested, there have been a few threads here in the forum that were started by people who were not able to collect enough stem cells. Maybe some of the threads will have useful ideas that you and your doctors can consider:
"Stem cell collection failed" (started Dec 25, 2014)
"Stem cell harvest failed - should I stress?" (started Jan 23, 2015)
"Difficulty harvesting stem cells" (started Dec 16, 2010)
If you want to review all stem cell collection discussions in the forum, this link (which is the result of an "advanced" search using the forum search box) should pull up just about all of them.
Good luck!
-
JimNY
Re: Stem cell collection canceled
Thanks for the links. I had no idea that this was even a possibility.
I am having another bone marrow biopsy and then we will see where we go from there.
I am having another bone marrow biopsy and then we will see where we go from there.
Re: Stem cell collection canceled
Hi BMyers,
My mom was diagnosed 7 years ago. When they collected, they only did enough for two transplants, which was fine at the time. Now as her cancer as progressed and she has run out of other options, we ended up at UAMS. Initially they thought she wouldn’t be able to collect, as her marrow was filled with plasma cells and damaged from 7 years of various myeloma treatments. In fact, after her D-PACE, it took her three weeks just for her white count to get over a 2.
She ended up receiving the higher of the two doses of growth factor shots given to patients, twice a day. As that didn’t seem to do anything, the doctor ordered her to take 100 mg of Promacta (eltrombopag) daily as well - which was when we started seeing improvements in her white count. She is also scheduled for the Mozobil before her collection, as well as during it.
They don’t expect her to collect a ton of cells, but hoping for enough for two transplants!
My mom was diagnosed 7 years ago. When they collected, they only did enough for two transplants, which was fine at the time. Now as her cancer as progressed and she has run out of other options, we ended up at UAMS. Initially they thought she wouldn’t be able to collect, as her marrow was filled with plasma cells and damaged from 7 years of various myeloma treatments. In fact, after her D-PACE, it took her three weeks just for her white count to get over a 2.
She ended up receiving the higher of the two doses of growth factor shots given to patients, twice a day. As that didn’t seem to do anything, the doctor ordered her to take 100 mg of Promacta (eltrombopag) daily as well - which was when we started seeing improvements in her white count. She is also scheduled for the Mozobil before her collection, as well as during it.
They don’t expect her to collect a ton of cells, but hoping for enough for two transplants!
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alward8599 - Name: Abby Ward
- Who do you know with myeloma?: Mother
Re: Stem cell collection canceled
Thanks, alward8599, for bringing up Promacta as an option for improving stem cell mobilization. I had not heard that the drug could be used in that way.
I did some digging, and apparently there was a trial carried out at Dana-Farber that looked at using Promacta to improve stem cell mobilization. The trial was small, with less than 20 patients, who were divided into four groups. Three of the groups received different doses of Promacta in addition Neupogen for mobilization (groups A, B, and C, with the Promacta dose increasing as you go fro A to C). The fourth group (group D) received only Neupogen.
The results indicate that Promacta seems to improve mobilization. For example, the median number of stem cells collected on the first day of harvesting was as follows:
Group D - 8.0
Group A - 11.0
Group B - 15.3
Group C - 26.4
Here's a reference for the abstract:
Laubach, JP, et al, A Pilot Study of Eltrombopag Plus G-CSF for Human CD34+ Cell Mobilization in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant, ASH 2016 annual meeting abstract #5815 (original text text of abstract)
Here's the text of the abstract:
Background: Administration of recombinant human thrombopoietin (rhTPO) with G-CSF for stem cell mobilization is associated with high CD34+ stem cell yield, rapid neutrophil recovery following autologus transplantation (ASCT), and decreased red blood cell (rbc) and platelet (plt) transfusions (Solomo, G. et al. Blood 1999). However, clinical development of rhTPO was complicated by the formation of neutralizing anti-TPO antibodies (Li, J. et al. Blood 2001), prompting discontinuation of further clinical development of recombinant TPO. Eltrombopag (Elt) is an orally bioavailable small molecule thrombopoietin receptor (TPO-R) agonist approved by the FDA for treatment of chronic immune thrombocytopenic purpura (ITP). In vitro studies have demonstrated that Elt promotes megakaryocyte proliferation and differentiation of CD34+ bone marrow progenitor cells (Erickson-Miller CL Stem Cells 2009), suggesting that Elt might be a surrogate for rhTPO for stem cell mobilization. In this pilot trial, we evaluated the combination of Elt plus standard G-CSF and cyclophosphamide (C) for stem cell mobilization in patients (pts) with multiple myeloma, a disease for which ASCT remains a standard of care (Blade et al. Blood 2010).
Methods: Primary objectives included determination of the median number of CD34+ cells/kg mobilized and the maximum tolerated dose (MTD) of Elt. Pts had multiple myeloma that was stable or responsive to at least two cycles of chemotherapy with plans for stem cell mobilization and ASCT. Four pts were to be enrolled in each of four dose escalation arms in which they received 0 (Arm D), 50 (Arm A), 100 (Arm B), or 150 mg (Arm C) of eltrombopag in combination with standard C + G-CSF. Adverse events (AEs) were graded by NCI-CTCAE v4.
Results: 17 pts have been screened and enrolled to date. Two patients withdrew consent prior to receiving Elt and were excluded from statistical analysis. 15 patients have completed participation in the study to date and two patients remain to be enrolled in Arm C. The first subject in Arm A experienced delayed engraftment that was determined to be unrelated to ELT; rather, the event was attributed to administration of a one-time high dose of corticosteroid for management of a severe hypersensitivity reaction to DMSO that occurred during stem cell infusion. A second subject in Arm A had undergone mobilization with Elt prior to the previously described delayed engraftment event, and to ensure safety underwent a second mobilization with G-CSF and plerixafor. During ASCT, this patient received cells from the second mobilization procedure. While neither event met criteria for a dose-limiting toxicity, the protocol was amended such that three additional patients enrolled in Arm A underwent two rounds of mobilization - the first with Elt plus C and G-CSF and a second with G-CSF plus plerixafor - and received as part of ASCT cells mobilized with Elt. Each of these patients engrafted successfully. The median number of CD34+ cells/kg collected during the first collection day of apheresis in Arms D, A, B, and C was 8.0, 11.0, 15.3, and 26.4. The median total number of CD34+ stem cells collected following mobilization with Elt plus C and G-CSF in Arms D, A, B, and C was 13.2, 12.7, 15.4, and 26.4. The percentage of patients in Arms D, A, B, and C who achieved a target collection of 8 x 10^6 CD34+ stem cells in one collection day was 50, 60, 75, and 100%. There have been no severe adverse events related to Elt .
Conclusions: Administration of Elt in combination with C plus G-CSF for stem cell mobilization in pts with multiple myeloma undergoing ASCT was safe and well tolerated, with no DLTs or severe AEs attributable to Elt. The small size of this pilot study precludes formal statistical comparison of outcomes across treatment Arms, but there appears to be a trend toward increase in yield of CD34+ cells and decrease in apheresis procedures required with increasing doses of Elt.
I did some digging, and apparently there was a trial carried out at Dana-Farber that looked at using Promacta to improve stem cell mobilization. The trial was small, with less than 20 patients, who were divided into four groups. Three of the groups received different doses of Promacta in addition Neupogen for mobilization (groups A, B, and C, with the Promacta dose increasing as you go fro A to C). The fourth group (group D) received only Neupogen.
The results indicate that Promacta seems to improve mobilization. For example, the median number of stem cells collected on the first day of harvesting was as follows:
Group D - 8.0
Group A - 11.0
Group B - 15.3
Group C - 26.4
Here's a reference for the abstract:
Laubach, JP, et al, A Pilot Study of Eltrombopag Plus G-CSF for Human CD34+ Cell Mobilization in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant, ASH 2016 annual meeting abstract #5815 (original text text of abstract)
Here's the text of the abstract:
Background: Administration of recombinant human thrombopoietin (rhTPO) with G-CSF for stem cell mobilization is associated with high CD34+ stem cell yield, rapid neutrophil recovery following autologus transplantation (ASCT), and decreased red blood cell (rbc) and platelet (plt) transfusions (Solomo, G. et al. Blood 1999). However, clinical development of rhTPO was complicated by the formation of neutralizing anti-TPO antibodies (Li, J. et al. Blood 2001), prompting discontinuation of further clinical development of recombinant TPO. Eltrombopag (Elt) is an orally bioavailable small molecule thrombopoietin receptor (TPO-R) agonist approved by the FDA for treatment of chronic immune thrombocytopenic purpura (ITP). In vitro studies have demonstrated that Elt promotes megakaryocyte proliferation and differentiation of CD34+ bone marrow progenitor cells (Erickson-Miller CL Stem Cells 2009), suggesting that Elt might be a surrogate for rhTPO for stem cell mobilization. In this pilot trial, we evaluated the combination of Elt plus standard G-CSF and cyclophosphamide (C) for stem cell mobilization in patients (pts) with multiple myeloma, a disease for which ASCT remains a standard of care (Blade et al. Blood 2010).
Methods: Primary objectives included determination of the median number of CD34+ cells/kg mobilized and the maximum tolerated dose (MTD) of Elt. Pts had multiple myeloma that was stable or responsive to at least two cycles of chemotherapy with plans for stem cell mobilization and ASCT. Four pts were to be enrolled in each of four dose escalation arms in which they received 0 (Arm D), 50 (Arm A), 100 (Arm B), or 150 mg (Arm C) of eltrombopag in combination with standard C + G-CSF. Adverse events (AEs) were graded by NCI-CTCAE v4.
Results: 17 pts have been screened and enrolled to date. Two patients withdrew consent prior to receiving Elt and were excluded from statistical analysis. 15 patients have completed participation in the study to date and two patients remain to be enrolled in Arm C. The first subject in Arm A experienced delayed engraftment that was determined to be unrelated to ELT; rather, the event was attributed to administration of a one-time high dose of corticosteroid for management of a severe hypersensitivity reaction to DMSO that occurred during stem cell infusion. A second subject in Arm A had undergone mobilization with Elt prior to the previously described delayed engraftment event, and to ensure safety underwent a second mobilization with G-CSF and plerixafor. During ASCT, this patient received cells from the second mobilization procedure. While neither event met criteria for a dose-limiting toxicity, the protocol was amended such that three additional patients enrolled in Arm A underwent two rounds of mobilization - the first with Elt plus C and G-CSF and a second with G-CSF plus plerixafor - and received as part of ASCT cells mobilized with Elt. Each of these patients engrafted successfully. The median number of CD34+ cells/kg collected during the first collection day of apheresis in Arms D, A, B, and C was 8.0, 11.0, 15.3, and 26.4. The median total number of CD34+ stem cells collected following mobilization with Elt plus C and G-CSF in Arms D, A, B, and C was 13.2, 12.7, 15.4, and 26.4. The percentage of patients in Arms D, A, B, and C who achieved a target collection of 8 x 10^6 CD34+ stem cells in one collection day was 50, 60, 75, and 100%. There have been no severe adverse events related to Elt .
Conclusions: Administration of Elt in combination with C plus G-CSF for stem cell mobilization in pts with multiple myeloma undergoing ASCT was safe and well tolerated, with no DLTs or severe AEs attributable to Elt. The small size of this pilot study precludes formal statistical comparison of outcomes across treatment Arms, but there appears to be a trend toward increase in yield of CD34+ cells and decrease in apheresis procedures required with increasing doses of Elt.
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JimNY
Re: Stem cell collection canceled
I also wanted to mention that the apheresis team stopped my moms acyclovir when she was just about to collect. They said it sometimes interferes with the collection process.
Hope you get to try again and have great success!
Hope you get to try again and have great success!
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alward8599 - Name: Abby Ward
- Who do you know with myeloma?: Mother
Re: Stem cell collection canceled
I was told that because I had been on Revlimid so long that it would be difficult to harvest the stem cells and would take 3 or 4 days. If they couldn't get enough, I would have to come back and try again. I read an article hyperbaric oxygen therapy and decided to use mild hyperbaric oxygen instead. It worked and I collect for two transplants in 8 hours. Here is a link to the article:
Puente, L, "Stem Cell Collection And Hyperbaric Oxygen Treatment," The Myeloma Beacon, Jan 11, 2011
Puente, L, "Stem Cell Collection And Hyperbaric Oxygen Treatment," The Myeloma Beacon, Jan 11, 2011
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Conundrum One - Name: Donna
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 1/21/15
- Age at diagnosis: 55
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