When I was first diagnosed with multiple myeloma five and a half years ago, my initial treatment consisted of induction chemotherapy with vincristine ^[1] (Oncovin), doxorubicin ^[2] (Adriamycin), and dexamethasone ^[3] (Decadron) followed by an autologous stem cell transplant.  I had a good response to the treatment but never quite got into remission.

The course of my disease over the next few years took me through a roller coaster of treatments with Revlimid ^[4] (lenalidomide), Revlimid with dexamethasone, Velcade ^[5] (bortezomib) alone, and Velcade plus Revlimid.  Each of these treatments resulted in a pretty good response which lasted anywhere from six months to a year. Eventually, I always relapsed.

I finally wound up on a clinical trial with pomalidomide ^[6] about which I have written in a previous post ^[7].  The clinical trial did not go well.  While pomalidomide did seem to work in at least stabilizing my disease, I ended up in the hospital with pneumonia.  We were forced to stop the pomalidomide treatment.

When I stopped taking the drug, my calcium levels quickly became dangerously high and my myeloma became very active.  I was getting pretty sick and running short on options.  My doctor recommended trying to get my disease back under control with chemotherapy with cyclophosphamide ^[8] (Cytoxan) and then a second stem cell transplant.

There has been a lot made of the tandem stem cell transplant protocol for newly diagnosed patients popularized by the University of Arkansas' Myeloma Institute for Research and Therapy (MIRT) .  This procedure involves using two stem cell transplants in fairly quick succession following induction chemotherapy.  The idea is to try to knock out any myeloma cancer cells that might survive the first transplant with the second transplant.

While controversy in the myeloma world still rages over whether this approach is better, most centers other than MIRT tend to use a single stem cell transplant approach.  However, even if only one stem cell transplant is planned, enough cells are harvested for two and maybe even three transplants at the time of stem cell harvest.  These cells can be stored frozen for almost an unlimited period of time.

The idea of using the stored stem cells for a second transplant in the relapse setting after failing many of the newer agents has come into vogue.  In fact, a few years ago, I asked about a second transplant, and it seemed no one thought it was of much benefit.

Now it was back on the table in a big way.  I am not sure exactly what changed, except that now that so-called novel agents like thalidomide ^[9] (Thalomid), Revlimid, and Velcade have been around for awhile, it seems that there are more and more people like me who have been on all of the newer drugs and have become resistant to them.  They are in need of another treatment option.

A recent article, which was actually highlighted at the Myeloma Beacon ^[10] last month, reported on the results of second transplant as salvage therapy.  The results were pretty encouraging and best for people who got a longer response to the first transplant.

As I mentioned, for me at that point the options were pretty limited.  I was sick in the hospital.  The high calcium levels were affecting my kidneys.  I was actually excited about the prospect of an aggressive treatment to get my disease back under control.

I had been through a stem cell transplant before.  I knew what it was all about.  Not fun, but if that was what it took, I was more than game.  Of course, I was having nightmares that they wouldn’t be able to find my cells from five years ago in that big freezer.

In the fall of 2010, I started two cycles of chemotherapy with cyclophosphamide, vincristine, doxorubicin, and dexamethasone.  The response was really encouraging.  My monoclonal protein level (M-spike) was dropping quickly, and despite the chemo, I was feeling better.  After about a three-week break, I was ready for the stem cell transplant.

My first stem cell transplant had been done on an outpatient basis.  For this one, it seemed there was no discussion.  I was going to be admitted to the hospital.

The Moffitt Cancer Center has a beautiful new transplant unit, and I knew they did a high volume of transplants.  I felt like I was in very good hands.

The preparative chemotherapy for the second transplant was different than for my first transplant.  I received six days of cyclophosphamide and busulfan ^[11] instead of the two days of melphalan ^[12] (Alkeran).  The net effect was the same: diarrhea, mouth sores, weakness, and nausea.  But the nurses and the whole transplant team seemed to be on top of everything, heading off small problems before they became big problems.

I received my stem cells (which they were able to find without any problem) at Christmas last year, and I engrafted after about 10 days.

Slowly everything started to improve.  After engrafting, every day was a little bit better.  Everyone, including my doctor, asked me how the second transplant compared to the first one.  Without a doubt, it was easier.  I knew what to expect, how to handle it, and I was not in awe of the process.

And finally, the results were good.  My M-spike dropped to a level of 0.1, and I returned to a relatively normal life.  I started maintenance treatment and was feeling great.

Would I do a transplant again?  In a heartbeat if I needed to, but now I’m out of cells.