Dr. Bensinger,
Thanks for being available for us. I would like to know your current thoughts on doing auto - mini allo tandem transplants. Is there an advantage in doing the allo? I did this using my brother's stem cells but sense that maybe the research is moving away from this.
Is this true?
Karen H.
Forums
6 posts
• Page 1 of 1
Re: auto allo tandem transplants
Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:
"Allogeneic stem cell transplants have the advantage of a completely myeloma-free stem cell product and an immunologic "graft-versus-myeloma" effect which results in more durable disease control than autologous transplants or conventional chemotherapy.
Allografts are, however, more complicated than autografts and due to slower immune reconstitution and "graft-versus-host disease", have more complications and a higher death rate.
The mini-allografts are safer but are still associated with a death rate of 15-20%. Furthermore, miniallografts are less effective than high dose therapy allografts due to a greater risk of relapse (still lower than autologous transplants). For these reasons, we regard allografts as investigational, generally only perform them within a clinical trial and are still trying to improve how we do these treatments."
"Allogeneic stem cell transplants have the advantage of a completely myeloma-free stem cell product and an immunologic "graft-versus-myeloma" effect which results in more durable disease control than autologous transplants or conventional chemotherapy.
Allografts are, however, more complicated than autografts and due to slower immune reconstitution and "graft-versus-host disease", have more complications and a higher death rate.
The mini-allografts are safer but are still associated with a death rate of 15-20%. Furthermore, miniallografts are less effective than high dose therapy allografts due to a greater risk of relapse (still lower than autologous transplants). For these reasons, we regard allografts as investigational, generally only perform them within a clinical trial and are still trying to improve how we do these treatments."
Re: auto allo tandem transplants
Dr. Bensinger,
Do you have any thoughts on the comparative success of allo transplants where the donor T cells are withheld initially and reintroduced gradually during the first year?
In my case the myeloma became active again in a plasmacytoma in less than a year after I did my first auto and radiation. I am not chemo resistant to Velcade and thalidomide, I have undergone a second auto and I'm about to radiate the same tumor a second time in preparation for an allo transplant.
I am 63, white, male and in my fourth year since diagnosis.
Do you have any thoughts on the comparative success of allo transplants where the donor T cells are withheld initially and reintroduced gradually during the first year?
In my case the myeloma became active again in a plasmacytoma in less than a year after I did my first auto and radiation. I am not chemo resistant to Velcade and thalidomide, I have undergone a second auto and I'm about to radiate the same tumor a second time in preparation for an allo transplant.
I am 63, white, male and in my fourth year since diagnosis.
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stansonsh
Re: Auto Allo Tandem Transplants
In terms of allo transplants, I certainly would be very hesitant to recommend that procedure in anybody, particularly someone who is 63 years old.
The risk of dying from graft vs. host disease is probably about the same percentage as your age.
The risk of having problems beyond that in terms of chronic graft vs. host disease is another probably 20%.
I think that this is important to recognize. Also, please see this response from me to an earlier question in the forum about transplantation in general.
The risk of dying from graft vs. host disease is probably about the same percentage as your age.
The risk of having problems beyond that in terms of chronic graft vs. host disease is another probably 20%.
I think that this is important to recognize. Also, please see this response from me to an earlier question in the forum about transplantation in general.
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Dr. James Berenson - Name: James R. Berenson, M.D.
Re: Auto Allo Tandem Transplants
Dr. Bensinger,
What are your thoughts on having a second Auto Transplant and is the benefit of having it for a patient with high risk deases ( monomsy 13 intially by conventional cytogentec and fish and currently by Fish 12/100)
My wife is a nonsecrotory diagnosed at age 40 with bone involvement and at time of diagnoses had 70% PC in BM and all the CRAP features.
Induction was with Velcade/DEX/Cytoxn. for 4 Cycles. followd by Auto Transplant. she achived VGPR prior to here transplant and was in CR with negatve Urine IFX and normal K/L ration for about 5 month.
Her Auto transplant was done in April 2009 and by September Urine IFX started shoing Kappa LC and her Serum FLC started showing up trend for the involved light chain (Kappa) and abnormal K/L Ratio.
she has not shown any evidence of Clincal Relaps ( normal RBC/HGL and normal Calcuim and Normal Kiddney Function, no changes on Skelt Servey).
Her Onc put her on a consolidation therapy (25 mg Revlimid for 2 cycles) which should about 16% drop in the invovled light chain and about 26% reduction in K/L ratio.
She started on maintence of 10 mg Revlimid few days ago.
We are getting mixed opinions. the BMT clinc are pushing here for a second Auto transplant right away and we and her Onc are feeling that it is not necessery at this time.
What is your opinion on this?
What are your thoughts on having a second Auto Transplant and is the benefit of having it for a patient with high risk deases ( monomsy 13 intially by conventional cytogentec and fish and currently by Fish 12/100)
My wife is a nonsecrotory diagnosed at age 40 with bone involvement and at time of diagnoses had 70% PC in BM and all the CRAP features.
Induction was with Velcade/DEX/Cytoxn. for 4 Cycles. followd by Auto Transplant. she achived VGPR prior to here transplant and was in CR with negatve Urine IFX and normal K/L ration for about 5 month.
Her Auto transplant was done in April 2009 and by September Urine IFX started shoing Kappa LC and her Serum FLC started showing up trend for the involved light chain (Kappa) and abnormal K/L Ratio.
she has not shown any evidence of Clincal Relaps ( normal RBC/HGL and normal Calcuim and Normal Kiddney Function, no changes on Skelt Servey).
Her Onc put her on a consolidation therapy (25 mg Revlimid for 2 cycles) which should about 16% drop in the invovled light chain and about 26% reduction in K/L ratio.
She started on maintence of 10 mg Revlimid few days ago.
We are getting mixed opinions. the BMT clinc are pushing here for a second Auto transplant right away and we and her Onc are feeling that it is not necessery at this time.
What is your opinion on this?
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Maher
Re: Auto Allo Tandem Transplants
Dr. William Bensinger from the Fred Hutchinson Cancer Research Center wrote:
stansonsh,
"T depletion as a means to reduce the complications of GVHD is effective, however, this technique is also associated with higher rates of disease relapse/progression due to the depletion of allo-reactive T cells capable of fighting the tumor resulting in a loss of graft-versus-tumor effects. T cell add back studies have been performed in an attempt to reintroduce allo-reactive T cells. To date the results are inconclusive in that it is not clear this successfully restores the graft-versus-tumor effects."
Maher,
"Available evidence suggests that second autotx are most effective when patients do not achieve a major response to treatment #1. Since your wife was in CR after treatment#1, a second autotx would probably not be of much help. It is entirely reasonable to use Revlimid as a form of maintenance after treatment; recent trials suggest substantial benefits for Revlimid in this role."
stansonsh,
"T depletion as a means to reduce the complications of GVHD is effective, however, this technique is also associated with higher rates of disease relapse/progression due to the depletion of allo-reactive T cells capable of fighting the tumor resulting in a loss of graft-versus-tumor effects. T cell add back studies have been performed in an attempt to reintroduce allo-reactive T cells. To date the results are inconclusive in that it is not clear this successfully restores the graft-versus-tumor effects."
Maher,
"Available evidence suggests that second autotx are most effective when patients do not achieve a major response to treatment #1. Since your wife was in CR after treatment#1, a second autotx would probably not be of much help. It is entirely reasonable to use Revlimid as a form of maintenance after treatment; recent trials suggest substantial benefits for Revlimid in this role."
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