This may sound like an odd idea, but it has started daunting on me and I would like some input.
I have written before that my sister developed multiple cutaneous plasmacytomas and is currently having treatment for them. The tumors grew soon after her first stem cell collection procedure. Today she is supposed to have a second collection, because her doctors want to have more cells just in case.
I can't brush off the thought that because the procedure involves stimulating release of plasma cells into the blood stream this could potentially contribute to plasma cells grouping into tumors outside bone marrow.
Does it make sense? I am really anxious now in case this new stem cell collection causes regrowth of extramedullary tumors, as my sister seems to be prone to them.
Forums
8 posts
• Page 1 of 1
-
Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
Re: Can stem cell mobilization cause extramedullary disease?
Your question is a good one. However, I do not know the answer as I’m not a myeloma expert. I think your sister should ask her physicians as to the risks of developing extramedullary myeloma due to stem cell mobilization. They ought to know.
I suppose that the probability of developing extramedullary myeloma post stem cell collection might depend upon the time lapse between a stem cell harvest and an autologous stem cell transplant. Presumably, any abnormal plasma cells released from the bone marrow would still be susceptible to the chemo agents being used in transplant procedure.
However, since some people collect their stem cells with the intention of using them at some future date, there might be a good database. It is this group which might show the most correlation between the development of extramedullary myeloma and stem cell harvesting.
Let us know if you find out anything more and good luck to your sister.
Joe
I suppose that the probability of developing extramedullary myeloma post stem cell collection might depend upon the time lapse between a stem cell harvest and an autologous stem cell transplant. Presumably, any abnormal plasma cells released from the bone marrow would still be susceptible to the chemo agents being used in transplant procedure.
However, since some people collect their stem cells with the intention of using them at some future date, there might be a good database. It is this group which might show the most correlation between the development of extramedullary myeloma and stem cell harvesting.
Let us know if you find out anything more and good luck to your sister.
Joe
-
Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: Can stem cell mobilization cause extramedullary disease?
Hi Gala,
That's a fascinating (and somewhat worrisome) idea. You may want to read this article, which doesn't specifically implicate cell mobilization in the development of extramedullary disease, but rather the overall auto transplant process:
Zeiser, R, et al, "Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma and its correlation to clinical outcome," Bone Marrow Transplantation," Nov 20014 (full text of article)
Excerpt:
That's a fascinating (and somewhat worrisome) idea. You may want to read this article, which doesn't specifically implicate cell mobilization in the development of extramedullary disease, but rather the overall auto transplant process:
Zeiser, R, et al, "Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma and its correlation to clinical outcome," Bone Marrow Transplantation," Nov 20014 (full text of article)
Excerpt:
"The transformation from primarily medullary (BM) to secondary extramedullary (EM) multiple myeloma after HSCT raises the question of whether transplantation can induce selection of plasma-cell clones with an altered biology. Preliminary reports provide evidence supporting this hypothesis."
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can stem cell mobilization cause extramedullary disease?
A couple of thoughts on this:
1. Mobilization is intended to get stem cells, not plasma cells, into the bloodstream. The harvesting process also is focused on harvesting stem cells, not plasma cells. That doesn't mean that plasma cells won't be mobilized, and that they won't end up in the harvested cells that are eventually re-infused. They sometimes do. But plasma cells are not the focus of the mobilization, harvesting, and reinfusion process.
2. Stem cell mobilization and harvesting is ideally intended to take place when the tumor burden in the marrow is low, which would significantly lower the chance of monoclonal plasma cells making their way into the bloodstream during mobilization. In Gala's sister's case, I believe she had a very good response (perhaps a complete response) when she underwent mobilization, so the number of myeloma cells in her marrow should have been relatively low.
3. It is known that extramedullary disease has become more common in relapsed myeloma patients since the use of novel agents. Yet novel agents also have deepened responses to initial myeloma therapy, which should reduce the chance of monoclonal plasma cells making their way out into the bloodstream during mobilization. This suggests that any connection between mobilization, harvesting, and extramedullary disease is weak, at least in comparison to other factors that can affect the development of extramedullary disease.
4. I guess it all depends on how one defines "rare", but I personally don't think something like extramedullary myeloma, which affects maybe 6-8 percent of newly diagnosed patients and 10-30 percent of relapsed patients, should be described as "rare".
Reference:
Touzeau, C, and Moreau, P, "How I treat extramedullary myeloma," Blood, Dec 2015 (full text of article)
1. Mobilization is intended to get stem cells, not plasma cells, into the bloodstream. The harvesting process also is focused on harvesting stem cells, not plasma cells. That doesn't mean that plasma cells won't be mobilized, and that they won't end up in the harvested cells that are eventually re-infused. They sometimes do. But plasma cells are not the focus of the mobilization, harvesting, and reinfusion process.
2. Stem cell mobilization and harvesting is ideally intended to take place when the tumor burden in the marrow is low, which would significantly lower the chance of monoclonal plasma cells making their way into the bloodstream during mobilization. In Gala's sister's case, I believe she had a very good response (perhaps a complete response) when she underwent mobilization, so the number of myeloma cells in her marrow should have been relatively low.
3. It is known that extramedullary disease has become more common in relapsed myeloma patients since the use of novel agents. Yet novel agents also have deepened responses to initial myeloma therapy, which should reduce the chance of monoclonal plasma cells making their way out into the bloodstream during mobilization. This suggests that any connection between mobilization, harvesting, and extramedullary disease is weak, at least in comparison to other factors that can affect the development of extramedullary disease.
4. I guess it all depends on how one defines "rare", but I personally don't think something like extramedullary myeloma, which affects maybe 6-8 percent of newly diagnosed patients and 10-30 percent of relapsed patients, should be described as "rare".
Reference:
Touzeau, C, and Moreau, P, "How I treat extramedullary myeloma," Blood, Dec 2015 (full text of article)
Re: Can stem cell mobilization cause extramedullary disease?
Hi Terry,
No arguments with what you stated here. But do note that while the mobilization process is clearly focused on mobilizing stem cells, it's impact on raising the level of circulating plasma cells (which are normally present only in extremely small numbers) is substantial:
Lemoli, RM, et al, "Concomitant mobilization of plasma cells and hematopoietic progenitors into peripheral blood of multiple myeloma patients: positive selection and transplantation of enriched CD34+ cells to remove circulating tumor cells," Blood, Feb 1996 (full text of article)
Excerpt:
"Kinetic analysis showed a pattern of tumor cell mobilization similar to that of normal hematopoietic progenitors with a maximum peak falling within the optimal time period for the collection of PBSCs. [After mobilization,] the absolute number of plasma cells showed a 10 to 50-fold increase as compared with the baseline value [prior to mobilization]."
No arguments with what you stated here. But do note that while the mobilization process is clearly focused on mobilizing stem cells, it's impact on raising the level of circulating plasma cells (which are normally present only in extremely small numbers) is substantial:
Lemoli, RM, et al, "Concomitant mobilization of plasma cells and hematopoietic progenitors into peripheral blood of multiple myeloma patients: positive selection and transplantation of enriched CD34+ cells to remove circulating tumor cells," Blood, Feb 1996 (full text of article)
Excerpt:
"Kinetic analysis showed a pattern of tumor cell mobilization similar to that of normal hematopoietic progenitors with a maximum peak falling within the optimal time period for the collection of PBSCs. [After mobilization,] the absolute number of plasma cells showed a 10 to 50-fold increase as compared with the baseline value [prior to mobilization]."
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can stem cell mobilization cause extramedullary disease?
Hello Joe, Terry and Multibilly.
Wow, so much to read! Thank you. For now I feel this is a very complex issue. I am looking forward to reading the articles.
In the meantime, my sister has yesterday undergone a second stem cells harvesting procedure and now has cells for at least two transplants. Doctors still think transplant is her best shot. I do hope it works and enables some positive dynamics.
Her transplant is scheduled for January, but they may move the date forward after another round of chemo to avoid another relapse.
Wow, so much to read! Thank you. For now I feel this is a very complex issue. I am looking forward to reading the articles.
In the meantime, my sister has yesterday undergone a second stem cells harvesting procedure and now has cells for at least two transplants. Doctors still think transplant is her best shot. I do hope it works and enables some positive dynamics.
Her transplant is scheduled for January, but they may move the date forward after another round of chemo to avoid another relapse.
-
Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
Re: Can stem cell mobilization cause extramedullary disease?
Gala,
And here's one more article that is more on point regarding your original question, but which is only a single case study:
Kobbe, G., et al, "Massive extramedullary disease progression in a patient with stable multiple myeloma during G-CSF priming for peripheral blood progenitor mobilization," Oncology Reports, Sep 1999 (abstract)
Abstract:
High dose therapy followed by autologous peripheral blood progenitor cell (PBPC) transplantation has recently become an encouraging treatment option for younger patients with multiple myeloma. The influence of the growth factors used for progenitor mobilization on myeloma cells is not known. We report on a patient suffering from IgG kappa myeloma who had been in stable, very good partial remission for seven months after standard therapy until PBPC mobilization with granulocyte-colony stimulating factor (G-CSF, Filgrastim) was initiated. Massive extramedullary disease progression occured coincidentally with the administration of G-CSF. The case suggest the possibility of myeloma stimulation by G-CSF during PBPC mobilization.
And here's one more article that is more on point regarding your original question, but which is only a single case study:
Kobbe, G., et al, "Massive extramedullary disease progression in a patient with stable multiple myeloma during G-CSF priming for peripheral blood progenitor mobilization," Oncology Reports, Sep 1999 (abstract)
Abstract:
High dose therapy followed by autologous peripheral blood progenitor cell (PBPC) transplantation has recently become an encouraging treatment option for younger patients with multiple myeloma. The influence of the growth factors used for progenitor mobilization on myeloma cells is not known. We report on a patient suffering from IgG kappa myeloma who had been in stable, very good partial remission for seven months after standard therapy until PBPC mobilization with granulocyte-colony stimulating factor (G-CSF, Filgrastim) was initiated. Massive extramedullary disease progression occured coincidentally with the administration of G-CSF. The case suggest the possibility of myeloma stimulation by G-CSF during PBPC mobilization.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can stem cell mobilization cause extramedullary disease?
Thank you, Multibilly!
So, it seems my hunch is not too far-fetched. I am really worried what this new mobilization and transplant would do in my sister's case. At the same time, it may be her best shot, considering her disease is aggressive and she cannot take these tough chemotherapy protocols continuously.
In any case, they have already harvested more cells. It would be too late to have a discussion with her doctors about it at this point. I know my sister is now very afraid of the transplant (almost in panic), though I did not share with her my thoughts about the issue we are discussing here, because the doctors' decision to harvest more was kind of spontaneous, when they saw that her white blood cell count became promisingly high. It all happened very quickly.
I'll keep you posted about the treatment progress.
So, it seems my hunch is not too far-fetched. I am really worried what this new mobilization and transplant would do in my sister's case. At the same time, it may be her best shot, considering her disease is aggressive and she cannot take these tough chemotherapy protocols continuously.
In any case, they have already harvested more cells. It would be too late to have a discussion with her doctors about it at this point. I know my sister is now very afraid of the transplant (almost in panic), though I did not share with her my thoughts about the issue we are discussing here, because the doctors' decision to harvest more was kind of spontaneous, when they saw that her white blood cell count became promisingly high. It all happened very quickly.
I'll keep you posted about the treatment progress.
-
Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
8 posts
• Page 1 of 1