Man... another question for the forum... I'm getting too busy here?
I am in chemo heading for a stem-cell transplant. My diagnosis is that I have monoclonal band iGg, with Lamba light chains. Stage 2, due to two tumours at T9 (cracked) and T12 (badly fractured Sept 22. I was basically immobile till Christmas, and still no real physical activity possible... I'd love to get Kyphoplasty on that one), radiated inFeb/ March with 2000 units of radiation hitting a 5x7" box over 5 sessions. Hot hot hot hits... slept a lot for a few of weeks after.
At time of initial diagnosis, the paraprotein level was 17.2 g/l, but over the course of two cycles of Velcade and Decadron, has dropped to 11.6 g/l. My guess is that the third cycle I am on now will drop it maybe another 5 or so, maybe down to 6 g/l.
I am scheduled currently for these three cycles, but I am guessing that still having the paraprotein that high will mean at least another cycle or two, right? What is a typical / optimal paraprotein level before they like to generate the stem cells for removal? I would think the lower the better, right?
Thanks for any responses, and sorry for all the traffic. Doing a lot of research...
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Snip - Name: John Snippe
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan, 2011
- Age at diagnosis: 56
Re: Optimal paraprotein level for stem cell transplant
The only test that EJs SCT doc has ever been interested in has been his bone marrow biopsy, not his paraprotien level. He wanted less than 10% involvement before he would do the transplant. EJ also took Velcade/dex. At the end of four cycles, when they did a second biopsy, his numbers went from 30 - 40% involvement, down to 15%. He had two more cycles, and his numbers went from 15% down to 3 - 5%.
From what I remember the doc telling us, with Velcade/dex its very rare to get a CR. They wanted to see that he responded well to the drugs, but getting his paraprotien level down was not the biggest priority.
I'm not sure that "lower is better" is always the correct way to go -- "lower" generally means you have to take more drugs, and these drugs - althought they do wonders - are no walk in the park. I think its more of a risk/benefit scenario. The risk of the side effects from the Velcade is not always worth the benefit, especially if a CR is rare.
Hope that helps.
Lyn
From what I remember the doc telling us, with Velcade/dex its very rare to get a CR. They wanted to see that he responded well to the drugs, but getting his paraprotien level down was not the biggest priority.
I'm not sure that "lower is better" is always the correct way to go -- "lower" generally means you have to take more drugs, and these drugs - althought they do wonders - are no walk in the park. I think its more of a risk/benefit scenario. The risk of the side effects from the Velcade is not always worth the benefit, especially if a CR is rare.
Hope that helps.
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Optimal paraprotein level for stem cell transplant
Christa's Mom wrote:
> The only test that EJs SCT doc has ever been interested in has been his
> bone marrow biopsy, not his paraprotien level. He wanted less than 10%
> involvement before he would do the transplant. EJ also took Velcade/dex.
> At the end of four cycles, when they did a second biopsy, his numbers went
> from 30 - 40% involvement, down to 15%. He had two more cycles, and his
> numbers went from 15% down to 3 - 5%.
<-- Snip™ -->
> Hope that helps.
>
> Lyn
It does. My initial diagnostic biopsy (before the chemo starte) came back at 10% ... and they've told me already that part of the next consult for the SCT will be another biopsy. So I guess my thinking was wrong... thanks for squaring that up for me!
> The only test that EJs SCT doc has ever been interested in has been his
> bone marrow biopsy, not his paraprotien level. He wanted less than 10%
> involvement before he would do the transplant. EJ also took Velcade/dex.
> At the end of four cycles, when they did a second biopsy, his numbers went
> from 30 - 40% involvement, down to 15%. He had two more cycles, and his
> numbers went from 15% down to 3 - 5%.
<-- Snip™ -->
> Hope that helps.
>
> Lyn
It does. My initial diagnostic biopsy (before the chemo starte) came back at 10% ... and they've told me already that part of the next consult for the SCT will be another biopsy. So I guess my thinking was wrong... thanks for squaring that up for me!
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Snip - Name: John Snippe
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan, 2011
- Age at diagnosis: 56
Re: Optimal paraprotein level for stem cell transplant
Hello John,
There is no "optimal or goal" paraprotein level or level of malignant plasma cells in the marrow for stem cell mobilzation and colllection.Simply put though.... lower is better. A complete remission (CR) at the time of stem cell collection is great but many patients will not have achieved CR prior to collection and transplant. The purpose of the transplant is to deepen the response and to achieve CR or VGPR in those patients who have not already done so. Most centers (and the literature) recommend having stem cell collection after the first 4-6 cycles of chemotherapy for newly diagnosed myeloma.
There is no "optimal or goal" paraprotein level or level of malignant plasma cells in the marrow for stem cell mobilzation and colllection.Simply put though.... lower is better. A complete remission (CR) at the time of stem cell collection is great but many patients will not have achieved CR prior to collection and transplant. The purpose of the transplant is to deepen the response and to achieve CR or VGPR in those patients who have not already done so. Most centers (and the literature) recommend having stem cell collection after the first 4-6 cycles of chemotherapy for newly diagnosed myeloma.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Optimal paraprotein level for stem cell transplant
Thanks, Doctor. I guess this means I will most probably be moving forward with the CTR process starting next week. I'll keep y'all posted 
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Snip - Name: John Snippe
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan, 2011
- Age at diagnosis: 56
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