Today is day +100 after my stem cell transplant. It got me to thinking: What is the significance of that milestone?
I have read various mentions of day +100, but it is not clear to me why that day is important. In my own case, having done the transplant outpatient, I saw my doctor at about one month post-transplant and then again two months later. At the initial appointment, we decided on a course of maintenance to be started whenever I felt well enough to begin. I started to take Revlimid about a month after that first appointment, or about two months after the transplant.
Perhaps the 100-day mark is for patients who have their transplants at a facility some distance from their home and that is an appropriate time to travel back for a check-up.
If anyone can shed some light on this I would appreciate it.
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Re: Stem cell transplant day +100 - why is it significant?
My understanding is that it is because for a while after transplant your M-spike numbers can go up and down erratically. So in order to get an accurate assessment of how effective SCT has been, you need to wait.
My M-spike continued to go down (from a low very value to not measurable) after day 100 even though I was on no treatment. Doc said this would be because paraproteins can have a half life of 3 months, so I could have some left to clear from blood.
Laura
My M-spike continued to go down (from a low very value to not measurable) after day 100 even though I was on no treatment. Doc said this would be because paraproteins can have a half life of 3 months, so I could have some left to clear from blood.
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: Stem cell transplant day +100 - why is it significant?
LauraScot,
I think you meant to say that the overall serum life (not half life) of paraproteins is about 3 months.
The half-life of monoclonal IgG (IgG has the longest half life of any of the heavy chains) is ~ 21 days. If you look at the light blue curve labeled E on figure 10.1 in this link
http://www.wikilite.com/wiki/index.php?title=Intact_immunoglobulin_multiple_myeloma_%28IIMM%29_-_theoretical_considerations_of_sFLC_and_Ig_measurements&oldid=12905
and then use your imagination to extrapolate the light blue E curve out beyond 20 days to when it would start to get close to zero, it would seem that the monoclonal IgG would indeed be pretty nearly all gone in about 3 months.
This didn't dawn on me before, but I guess that folks with non-IgG type multiple myeloma may know more quickly than IgG-type multiple myeloma folks whether a given treatment is working or not....at least if you are using the M-Spike as your measure and not serum free light chains (which only live for hours).
I think you meant to say that the overall serum life (not half life) of paraproteins is about 3 months.
The half-life of monoclonal IgG (IgG has the longest half life of any of the heavy chains) is ~ 21 days. If you look at the light blue curve labeled E on figure 10.1 in this link
http://www.wikilite.com/wiki/index.php?title=Intact_immunoglobulin_multiple_myeloma_%28IIMM%29_-_theoretical_considerations_of_sFLC_and_Ig_measurements&oldid=12905
and then use your imagination to extrapolate the light blue E curve out beyond 20 days to when it would start to get close to zero, it would seem that the monoclonal IgG would indeed be pretty nearly all gone in about 3 months.
This didn't dawn on me before, but I guess that folks with non-IgG type multiple myeloma may know more quickly than IgG-type multiple myeloma folks whether a given treatment is working or not....at least if you are using the M-Spike as your measure and not serum free light chains (which only live for hours).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Stem cell transplant day +100 - why is it significant?
Interesting question, Andrew.
I don't think the 100-day timing has anything to do with whether a transplant is done outpatient or inpatient, or whether transplants were traditionally done inpatient in the past.
I think the main issue is that the body, in general, needs time to get back to an equilibrium after a transplant. It takes time for the reinfused stem cells to settle back into the bone marrow, spread, and get back to producing blood cells at a normal level. The body also needs time to work off the side effects of the high-dose chemo prior to the transplant. The immune system, as it is being re-formed, also is getting back to fighting whatever myeloma cells are left in the body, not to mention any infections which may have occurred.
So I'm guessing that physicians just don't feel comfortable drawing any conclusions about where things stand until this equilibrating process is basically complete. Unless, of course, there are really clear signs that things are not working out the way they should (which, hopefully, doesn't occur too often).
I don't think the 100-day timing has anything to do with whether a transplant is done outpatient or inpatient, or whether transplants were traditionally done inpatient in the past.
I think the main issue is that the body, in general, needs time to get back to an equilibrium after a transplant. It takes time for the reinfused stem cells to settle back into the bone marrow, spread, and get back to producing blood cells at a normal level. The body also needs time to work off the side effects of the high-dose chemo prior to the transplant. The immune system, as it is being re-formed, also is getting back to fighting whatever myeloma cells are left in the body, not to mention any infections which may have occurred.
So I'm guessing that physicians just don't feel comfortable drawing any conclusions about where things stand until this equilibrating process is basically complete. Unless, of course, there are really clear signs that things are not working out the way they should (which, hopefully, doesn't occur too often).
Re: Stem cell transplant day +100 - why is it significant?
Thank you for the info Multibilly, very interesting. I have IgG type, so this would explain why my paraprotein took so long to drop fully.
Laura
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: Stem cell transplant day +100 - why is it significant?
Dear Goldmine,
The 100 days, as I was told by my myeloma specialist, is the time frame for the stem cells to register in your blood work, that they have gone to work and are currently rebuilding your immune system.
Years ago, they used a donor marrow only for stem cell transplants (SCTs), and that took a long time to migrate to your bone marrow. (Approximately 100 days). And the 100 days for you to have a strong enough immune system that will allow you to walk along the ward for exercise!
I hope this helps. I'm 2 years out from my SCT and in remission and doing well.
Mary
The 100 days, as I was told by my myeloma specialist, is the time frame for the stem cells to register in your blood work, that they have gone to work and are currently rebuilding your immune system.
Years ago, they used a donor marrow only for stem cell transplants (SCTs), and that took a long time to migrate to your bone marrow. (Approximately 100 days). And the 100 days for you to have a strong enough immune system that will allow you to walk along the ward for exercise!
I hope this helps. I'm 2 years out from my SCT and in remission and doing well.
Mary
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Mary Degenkolb - Name: Mary Degenkolb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2011
- Age at diagnosis: 54
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