I had my stem cells collected after a year of different types of therapy. My Mspike was still in the 2.5 range when collected.
Does this mean that my stem cells in storage have myeloma cells? Do they clean these cells out before replanting them back into me?
If I get a second transplant, should I try to get a more recent harvest since my multiple myeloma load will be lower at that time? (I have enough cells in storage for 2 transplants but I wonder if they are "dirtier" than desired)
Thanks, Stan
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Re: Where's the myeloma?
Stan, my understanding is that the stored stem cells are "not cleaned". I'm hoping one of the physicians that posts to the site will answer your question from a professional stand point. I'm sure your treating physicians were comfortable with the collection knowing where your M spike was. Best wishes to you. Kay
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Kansas - Name: Rex
- Who do you know with myeloma?: self
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 61
Re: Where's the myeloma?
Great question! I've been curious but I've never managed to ask the question, always too many other things happening. Looking forward to an answer from the professionals. 
Re: Where's the myeloma?
Hello, Stan-
Let me give you my impression as a medical writer and myeloma patient--not a physician. I asked my myeloma docs at Mayo about this when I was being harvested. Initially, collections were "scoured" and filtered in an attempt to remove any myeloma cells. They don't do that anymore--it was discovered it didn't help. My take on the process is this: The average auto stem cell transplant (ASCT) using your own cells only works for 18 months. You spend three or four months "wiped-out," as your system recovers and the transplanted cells take hold. It takes a year or so for everything to get moving again. At that point the myeloma cells may in fact start to grow again, but hopefully at a slower rate than before. 2.5 M-Spike is a high number for a collection. But in the end, it is the rate they begin to grow again that is important. So if you stay around the 2.5 range all is OK. That could last for years--or only a few short months. Think of the process as a way to buy some more time until carfilzomib and pomalidomide hit the market. I know patients who are in your situation who have lived many, many years--and that's without any of these new "wonder drugs" or even Revlimid or Velcade. Good luck! Pat
Let me give you my impression as a medical writer and myeloma patient--not a physician. I asked my myeloma docs at Mayo about this when I was being harvested. Initially, collections were "scoured" and filtered in an attempt to remove any myeloma cells. They don't do that anymore--it was discovered it didn't help. My take on the process is this: The average auto stem cell transplant (ASCT) using your own cells only works for 18 months. You spend three or four months "wiped-out," as your system recovers and the transplanted cells take hold. It takes a year or so for everything to get moving again. At that point the myeloma cells may in fact start to grow again, but hopefully at a slower rate than before. 2.5 M-Spike is a high number for a collection. But in the end, it is the rate they begin to grow again that is important. So if you stay around the 2.5 range all is OK. That could last for years--or only a few short months. Think of the process as a way to buy some more time until carfilzomib and pomalidomide hit the market. I know patients who are in your situation who have lived many, many years--and that's without any of these new "wonder drugs" or even Revlimid or Velcade. Good luck! Pat
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Pat Killingsworth - Name: Pat Killingsworth
- Who do you know with myeloma?: I am a multiple myeloma patient
- When were you/they diagnosed?: April, 2007
- Age at diagnosis: 51
Re: Where's the myeloma?
Dear Stan,
We forwarded your question to Dr. Edward Stadtmauer, Director of the Bone Marrow and Stem Cell Transplant Program at the Abramson Cancer Center, University of Pennsylvania, and he said the following:
"This is a common question and an important issue. On the one hand, it does not make sense that autologous stem cell transplant should work in myeloma. No matter how high the dose of chemotherapy that is given, we are infusing back afterwards stem cells that may be contaminated with myeloma cells. On the other hand, decades of clinical studies show a benefit for autologous transplant. Therefore, the infused stem cells must either contain such a low level of myeloma cells as to be inconsequential or the cells that are there are not capable of inducing relapse of the disease.
Our current approach is not to try to ‘clean’ the cells prior to reinfusion. This process tends to destroy a percentage of cells, and processed cells may not grow back as fully and lead to other problems (low blood counts, infections bleeding) in the future. A number of studies were conducted in the 1990’s using techniques to clean or purge the cells of myeloma, and they showed no advantage over un-purged transplants.
It is unclear that there is any difference in the outcome using cleaner or dirtier cells. The decision about further harvesting is usually made based on the quantity of cells remaining and how long they have been stored. The lower the quantity and the longer the time between harvest and use the more I have enthusiasm for collecting more."
We forwarded your question to Dr. Edward Stadtmauer, Director of the Bone Marrow and Stem Cell Transplant Program at the Abramson Cancer Center, University of Pennsylvania, and he said the following:
"This is a common question and an important issue. On the one hand, it does not make sense that autologous stem cell transplant should work in myeloma. No matter how high the dose of chemotherapy that is given, we are infusing back afterwards stem cells that may be contaminated with myeloma cells. On the other hand, decades of clinical studies show a benefit for autologous transplant. Therefore, the infused stem cells must either contain such a low level of myeloma cells as to be inconsequential or the cells that are there are not capable of inducing relapse of the disease.
Our current approach is not to try to ‘clean’ the cells prior to reinfusion. This process tends to destroy a percentage of cells, and processed cells may not grow back as fully and lead to other problems (low blood counts, infections bleeding) in the future. A number of studies were conducted in the 1990’s using techniques to clean or purge the cells of myeloma, and they showed no advantage over un-purged transplants.
It is unclear that there is any difference in the outcome using cleaner or dirtier cells. The decision about further harvesting is usually made based on the quantity of cells remaining and how long they have been stored. The lower the quantity and the longer the time between harvest and use the more I have enthusiasm for collecting more."
Re: Where's the myeloma?
As I said before I have wondered that very thing, how can my cells help put my multiple myeloma in remission. Well it didn't. After two unsuccessful autos stem cell transplants and now as of yesterday I had my third and final stab at remission, my allo, using my sister's perfectly matched cells.
One wonders why we did not take this approach in the beginning. I realize the first and second time around with my autos my multiple myeloma was not what it is now or should I say what it was yesterday. It morphed into a beastly acute case. So that may be the reason. But I can tell you my body is tired, beat up and ready for a reprieve.
So here I sit in my hospital room at MD Anderson at day +1. Mild nausea and no appetite. I have high hopes.
One wonders why we did not take this approach in the beginning. I realize the first and second time around with my autos my multiple myeloma was not what it is now or should I say what it was yesterday. It morphed into a beastly acute case. So that may be the reason. But I can tell you my body is tired, beat up and ready for a reprieve.
So here I sit in my hospital room at MD Anderson at day +1. Mild nausea and no appetite. I have high hopes.
Re: Where's the myeloma?
Hi Stan,
Just happened to be surfing through the Beacon Forum and came across your posting. Just wanted to say that you sound very courageous and I wish you all the best!
Steve
DX SBP 2010
Irradiation & watch and wait
Just happened to be surfing through the Beacon Forum and came across your posting. Just wanted to say that you sound very courageous and I wish you all the best!
Steve
DX SBP 2010
Irradiation & watch and wait
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Steve - Name: Steve
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: December 2009
- Age at diagnosis: 55
Re: Where's the myeloma?
Thank you to everyone for posting a response. Those are great answers.
And to Trainier. Hang in there. Your allo offers the best chance for a cure.
And to Trainier. Hang in there. Your allo offers the best chance for a cure.
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Stan
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