The doctor told my husband and me that it was time to do a stem cell collection. His numbers are still high and his last bone marrow biopsy (September) came back with 30% myeloma. She said his bone marrow was not that healthy and I think she is afraid it will be hard to get enough stem cells if we continue with Revlimid and Velcade.
He started Revlimid 25 mg April, stopped Revlimid July, started Velcade July, added Revlimid at 5 mg October 2011. He is very sensitive to the higher doses of Revlimid and had a reduction in the Velcade strength. As of August his numbers were,
IgA 15
IgG 3644
IgM 35
Lambda FLC 17.3
Kappa FLC 9.09
Kappa-Lambda FLC Ratio 0.5
Total Protein 9
M-spike 2.78
Is this a good time for the collection, is there any certain point that you need to reach?
I thought I was starting to understand all this, but I am a bit confused now. We go back to see her on Monday, maybe we should seek another opinion? Do the stem cells have myeloma in them?
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KellieLyn - Name: Kellie
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 48
Re: When is a good time for stem cell collection?
The collection of stems cells is sometimes a moving target. The simple answer is, we like to harvest cells after 4 cycles (and really before 6-8) of Revlimid therapies. This is because although Revlimid is a very good drug for the treatment of myeloma, it has some myelosuppression effects too (affects the bone marrow). As such, prolonged use can make it difficult to harvest enough cells for the transplant and it is important to collect an adequate number of stem cells for the procedure (ideally , enough for two.). So, when on Revlimid, it is a balance between number of cycles (as above) and maximizing response with therapy.
I don't know your husband's diagnosis numbers or what they are today, but as long as you are responding it is reasonable to harvest. Ideally, we like patients to achieve at least a partial response (>50% reduction in paraprotein) and some studies suggest that achieving at least a very good partial response (>90%) is better.
Most patients are concerned about the left-over plasma cells in the bone marrow: "won't they get back in with the transplant?" My answer is the following. There have been studies in which the myeloma cells are "removed" from the stem cells collection. Interestingly, this course of action did not change outcomes. So, although it may not seem logical, the data indicates that control of disease with induction therapy (responses) is the most important aspect. So, please try not to be confused or concerned by the percent plasma cells in the marrow. or evidence of disease in his serum or urine.
It is also important to remember that transplant is really "high-dose melphalan consolidation" of your induction therapy, to improve the response you received from induction therapy. The stem cells are "only" to support you through the highly toxic treatment. And I believe that this step is an important aspect to therapy in the right individuals after successful induction therapy. And in the right cases, even for those who have not been as successful with induction.
I hope that this helps to some degree. There is not a straightforward question or answer.
I don't know your husband's diagnosis numbers or what they are today, but as long as you are responding it is reasonable to harvest. Ideally, we like patients to achieve at least a partial response (>50% reduction in paraprotein) and some studies suggest that achieving at least a very good partial response (>90%) is better.
Most patients are concerned about the left-over plasma cells in the bone marrow: "won't they get back in with the transplant?" My answer is the following. There have been studies in which the myeloma cells are "removed" from the stem cells collection. Interestingly, this course of action did not change outcomes. So, although it may not seem logical, the data indicates that control of disease with induction therapy (responses) is the most important aspect. So, please try not to be confused or concerned by the percent plasma cells in the marrow. or evidence of disease in his serum or urine.
It is also important to remember that transplant is really "high-dose melphalan consolidation" of your induction therapy, to improve the response you received from induction therapy. The stem cells are "only" to support you through the highly toxic treatment. And I believe that this step is an important aspect to therapy in the right individuals after successful induction therapy. And in the right cases, even for those who have not been as successful with induction.
I hope that this helps to some degree. There is not a straightforward question or answer.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: When is a good time for stem cell collection?
Thanks for the reply you really helped me understand the whole thing better!
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KellieLyn - Name: Kellie
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 48
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