After the first transplant, my 71 year-old mom reached VGPR with a non-quantifiable monoclonal component, with a positive immunofixation, with one IgG K and two IgG lambda.
After the second, the result has not changed, and she has not reached a complete response, she's still at VGPR with the same values.
Before the transplant, she had no IgG K, only IgG lambda. My mom's illness is characterised by 1q t4,14 cytogenetic abnormalities.
I'm worried about the results from blood tests. They show high levels of beta-2 microglobulin (5.32 mg/l). I know this is a bad prognostic factor too, but the physician says to me it is not always correlated with a progression. She has Freelite chain lambda and k in the serum, 42.5 and 39.3 mg/l respectively. They are not present in her urine, and the Bence Jones protein is negative.
Doctors are telling me that it could be a sign of marrow function recovery, but I'm still worried about those values. These values show up on the re-evaluation two months after the second transplant. Tomorrow we have the three month re-evaluation, with a marrow biopsy which should give more reliable data.
If the VGPR is confirmed, I am evaluating whether to follow a maintenance therapy or a consolidation therapy (with Velcade-thalidomide-dexamethasone), but I'm scared that thalidomide, like lenalidomide [Revlimid], has thrombosis as a possible side effect, and could cause another intestinal stroke, like the one caused by her first line therapy (Revlimid-dexamethasone), which led to the removal of 1m of intestine.
The intestinal stroke happened even if she takes heparin under my request, because I think it's safer then the aspirin, it's not worked anyway. One physician specialized in myeloma who I have a visit before the 2nd ASCT say to me that the risk is not the same now that my mother have a N.Q. m component, when the intestinal stroke happened she have a monoclonal component of 35g/L.
I know the consolidation is only for 2 months, but this is what happened with Revlimid-dex (2.5 cycles).
She is scheduled for surgery within the next 2 months for an incisional hernia, following the operation for the intestinal stroke.
Should we wait and start the therapy after the surgery? Is there any risk of complications either way? What are your thoughts?
Thanks for the responses.
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Re: Options for VGPR after second stem cell transplant?
I'm sorry to hear about the challenges your mother is facing, Manuel.
As far as her surgery is concerned, I think that is an issue you will have to leave up to her physicians. There are probably a number of different issues that have to be considered, and it would require some very intimate knowledge of your mother's case to really make a good recommendation.
Regarding your question about consolidation therapy, I am not sure I understand what the options are that you are considering. You mentioned VTD as an option for consolidation therapy, but you also mentioned maintenance therapy. What is the maintenance therapy option that is being considered?
Given your mother's cytogenetics and the fact that she has not achieved more than a VGPR after two stem cell transplants, it seems that her disease is relatively aggressive. This is probably why her physicians are recommending consolidation therapy, perhaps to be followed by maintenance therapy as well. This seems reasonable.
What was your mother's initial therapy, prior to her first transplant, and did she receive any treatment between the first and second transplant?
I ask because her physicians also may be trying to reserve some of the newer therapies, such as Pomalyst or Kyprolis (or investigational drugs) until they are absolutely certain she is no longer responding to somewhat older therapies.
As far as her surgery is concerned, I think that is an issue you will have to leave up to her physicians. There are probably a number of different issues that have to be considered, and it would require some very intimate knowledge of your mother's case to really make a good recommendation.
Regarding your question about consolidation therapy, I am not sure I understand what the options are that you are considering. You mentioned VTD as an option for consolidation therapy, but you also mentioned maintenance therapy. What is the maintenance therapy option that is being considered?
Given your mother's cytogenetics and the fact that she has not achieved more than a VGPR after two stem cell transplants, it seems that her disease is relatively aggressive. This is probably why her physicians are recommending consolidation therapy, perhaps to be followed by maintenance therapy as well. This seems reasonable.
What was your mother's initial therapy, prior to her first transplant, and did she receive any treatment between the first and second transplant?
I ask because her physicians also may be trying to reserve some of the newer therapies, such as Pomalyst or Kyprolis (or investigational drugs) until they are absolutely certain she is no longer responding to somewhat older therapies.
Re: Options for VGPR after second stem cell transplant?
Thank you Cheryl G for your response
My mother went from 2.5 cycle of Revlimid-dex, then she's have a complication with an intestinal stroke and she stop her therapy. After this complication, she's start three cycle of PAD [Velcade, doxorubicin (Adriamycin), dexamethasone] before the stem cell collect, and then she have two ASCT without any treatment between the two transplant, and here we are.
You have right, I'm not sufficent clear in my previously post: consolidation is based on two cycle of VTD,and probably I have to pay my self this therapy.
The other option is maintenace with Velcade - dex, but I think I can't handle this with my limited resource of money, maybe there is a trial, but is very far away from your home 480 miles. I'm investigated for this and talk about this option with the physician who takes care of my mother now.
Another option this time covered by our Italian health care system is maintenance with thalidomide and dexamethasone for one year. This is available at the hospital where my mother receive her current therapy, but I don't like this option.
I have a limited amount of resource. Do you think is now with VTD the time to spend it?
My thoughts are this:
I think my mother don't like to be always in therapy, this three months, at least the first half post transplant, she's feeling sad to be not able to do home work, cooking, help me with our family business Say to me she's feeling useless, I try to comfort her saying I need her love not her work, but she's a woman who spend her entire life on the care of her family and working.
And beside this, for what I learned, generally maintenance prolong the PFS, but not the overall survival. If my thoughts are right, is not better to get her a free-treatment time?
We are waiting for the analysis, the beta 2 microglobulin now is lower at 3.67mg/l. Tomorrow we have total body x-ray and we are waiting for the result of bone marrow bipbsy, electrophoresis and immunofixation, and we wait a call for the nuclear magnetic resonance.
i'm hoping at least she's maintaining her VGPR.
My mother went from 2.5 cycle of Revlimid-dex, then she's have a complication with an intestinal stroke and she stop her therapy. After this complication, she's start three cycle of PAD [Velcade, doxorubicin (Adriamycin), dexamethasone] before the stem cell collect, and then she have two ASCT without any treatment between the two transplant, and here we are.
You have right, I'm not sufficent clear in my previously post: consolidation is based on two cycle of VTD,and probably I have to pay my self this therapy.
The other option is maintenace with Velcade - dex, but I think I can't handle this with my limited resource of money, maybe there is a trial, but is very far away from your home 480 miles. I'm investigated for this and talk about this option with the physician who takes care of my mother now.
Another option this time covered by our Italian health care system is maintenance with thalidomide and dexamethasone for one year. This is available at the hospital where my mother receive her current therapy, but I don't like this option.
I have a limited amount of resource. Do you think is now with VTD the time to spend it?
My thoughts are this:
I think my mother don't like to be always in therapy, this three months, at least the first half post transplant, she's feeling sad to be not able to do home work, cooking, help me with our family business Say to me she's feeling useless, I try to comfort her saying I need her love not her work, but she's a woman who spend her entire life on the care of her family and working.
And beside this, for what I learned, generally maintenance prolong the PFS, but not the overall survival. If my thoughts are right, is not better to get her a free-treatment time?
We are waiting for the analysis, the beta 2 microglobulin now is lower at 3.67mg/l. Tomorrow we have total body x-ray and we are waiting for the result of bone marrow bipbsy, electrophoresis and immunofixation, and we wait a call for the nuclear magnetic resonance.
i'm hoping at least she's maintaining her VGPR.
3 posts
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