Stem cell treatment

 

 Good Morning MMs;

I think Cancer compass was correct in letting this post, as yes some people are very fearful, but others will research.  Once again the person here (in my town_) who is having it, had a zero protein count, so technically he did not show any MM cells at the time of harvest. Yes they try and kill off as many of the bad cells that can be done.

If you really feel comfortable with the original post, without any supportive website or newsletter, being commented on, how about I post this tomorrow:

"Dear MMS, did you see the latest website that Multiple Myeloma can be cured! Yes that's right! And with only six oral pills. Very similiar to a "Z-Pack" if you had a bad cold. Two the first day, and then one each day following. No side effects, no age restrictions, FDA approved. I can't wait to get mine. How about you?"

I do agree with you that people will search, and search, and search for this elusive webpage. When all that had to be done from the get go was post it with the comments. A fellow member here (PHOTOG) backs up all his posts with the website he received it from for all to do their own research. If people want to send messages like the original, do it privately.

Take care;

Kevin

Hooray Kevin!!  Fantastic message!!  So true, which was why I didn't comment on the original message without getting confirmation and explaination.  This site is for VALIDITY, TRUTH, and much much more than hearsay!!  How can anyone make an informed choice from supposition and casual observation which is pedaled as fact?  I'm sure that most can tell the difference, however lately it has been a worry when someone comments indiscriminately -- I fear for others who could assume that they were reading the truth, when they are NOT.  I applaud your message and example -- well done!!  Cath

There appears to be concern and confusion about an article recently posted about stem cell resistance in MM.  Keep in mind this article has nothing to do with stem cell transplants in MM.  It is talking about why MM is so resistant to most treatment.  Actually this entire article is theoretical.  The theory suggests that conventional chemotherapy kills differentiated or differentiating cells, which form the bulk of the tumor but are unable to generate new cells. A population of cancer stem cells, which gave rise to it, could remain untouched and cause a relapse of the disease.  This entire topic of cancer stem cells is controversial in cancer research.  Allogeneic SCT or a tandem transplant remains a viable possibility for many patients to obtain a complete response.

 

On 2/5/2008 Oncrx wrote:

There appears to be concern and confusion about an article recently posted about stem cell resistance in MM.  Keep in mind this article has nothing to do with stem cell transplants in MM.  It is talking about why MM is so resistant to most treatment.  Actually this entire article is theoretical.  The theory suggests that conventional chemotherapy kills differentiated or differentiating cells, which form the bulk of the tumor but are unable to generate new cells. A population of cancer stem cells, which gave rise to it, could remain untouched and cause a relapse of the disease.  This entire topic of cancer stem cells is controversial in cancer research.  Allogenic SCT or a tandem transplant remains a viable possibility for many patients to obtain a complete response.

'The Johns Hopkins scientists also compared the response of these special stem cells with the bulk of multiple myeloma plasma cells, to four different chemotherapy medications commonly used to treat patients with the disease: dexamethasone, lenadilomide, bortezomib and 4-hydroxycyclophosphamide. While all four agents significantly inhibited the growth of the plasma cells, none inhibited the stem cells.

To their surprise, the research team noted that the multiple myeloma stem cells resemble other types of adult stem cells and exhibit similar properties that may make them resistant to chemotherapy. They found that the stem cells contain high levels of enzymes that neutralize toxins, like cancer drugs, and expel them through miniature pumps on their cell surface. The investigators believe that these drug-fighting enzymes and pumps - also plentiful in normal stem cells - may help cancer stem cells resist treatment.

"Nature made normal stem cells very hearty for a reason, namely to survive and help repair damaged tissues and organs after injury or illness," says William Matsui, M.D., an assistant professor of oncology at Hopkins and the study s lead investigator. "To us, it makes sense that the same processes that protect normal stem cells also exist in cancer stem cells to make them resistant to chemotherapy. We need to develop new ways to target the specific biology of cancer stem cells to prevent the continued production of mature tumor cells and disease relapse." '

Good Evening Oncrx;

The "confusion" you mention on my part was based upon an article being discussed without citing said article. I like to read and keep as informed as I can. Without the article it's mere heresay to me.

However, if the article you are now referring to is the same one from CC front page, which I have copied a part from and listed above, I do not completely agree with your comments.

My understanding from reading the article is that cancer stem cells and normal stem cells share the same "pumps" that expel the chemo from the cells before they can harm it. Which to me only only stand to reason, after all, my understanding of cancer cells in MM is that they don't mature into reds, whites or platelets. (Besides reproducing like crazy) So they would share all the components that normal cells have. And therefore have the same resistive properties that normal cells contain. This reminds me of the quote: "That which does not kill me only makes me stronger." I don't recall who said this but I'd bet he was a former Marine!

I would like to question you on the type of transplant. Allogenic is from a person who may not contain cancer cells in their stems. Autologous, in my case, most definately contain the cancer cells. However, you mention a Tandem transplant. I presume this is a combination of the two? If this is correct, does the donor's stem cells attack my cancerous ones? How do they positively attack my cells without causing graft vs. host? If they medicate me to prevent graft vs. host does this prevent his cells from destroying the cancerous ones within me? What is the advantage of having a tandem transplant? Are there any disadvantages?

Thank you;

Kevin

 

Kevin

Always good talking with you about MM.  My concern was that I thought I read several people comment that SCT was not a good idea because of this article.  I dont believe thats what the article said.  The theoretical concept is that cancer cells originate from cancer stem cells so even if you kill all the cancer cells, the cancer stem cells will cause a relapse.  The cancer stem cells are already there, they dont come from a transplant. 

Recently, a multi-institutional clinical trial was conducted to evaluate the effectiveness of treatment utilizing an autologous stem cell transplant followed by a mini allogeneic stem cell transplant for recurrent multiple myeloma. This is called a tandem transplant.  The reason for this type of therapeutic approach is to reduce the number of cancer cells in the body with an autologous stem cells transplant, so that the donor stem cells have a small number of cancer cells to attack. The following allogeneic transplant is key as the graft vs tumor effect is essential. The graft recognizes remaining cancer cells as foreign and attacks them.   If all you get is an autologous transplant, relapse will always occur.  In this study nearly 60% of patients had a complete response.  The problem?  GvHD occured in 40% of patients with a 17% mortality.  In these types of transplants GvHD is hard to prevent even with pretreatment meds.  Depends partly on how good the match is.  At any rate it could be worth discussing with your doc or looking into a clinical trial. Do you have a major transplant center near you?  Here is the reference for your review.

Maloney DG, Molina AJ, Sahebi F, et al. Allografting with Nonmyeloablative Conditioning Following Cytoreductive Autografts for the Treatment of Patients with Multiple Myeloma. Blood. 2003;102:3447-3454

 

On 2/6/2008 Oncrx wrote:

Kevin

Always good talking with you about MM.  My concern was that I thought I read several people comment that SCT was not a good idea because of this article.  I dont believe thats what the article said.  The theoretical concept is that cancer cells originate from cancer stem cells so even if you kill all the cancer cells, the cancer stem cells will cause a relapse.  The cancer stem cells are already there, they dont come from a transplant. 

Recently, a multi-institutional clinical trial was conducted to evaluate the effectiveness of treatment utilizing an autologous stem cell transplant followed by a mini allogeneic stem cell transplant for recurrent multiple myeloma. This is called a tandem transplant.  The reason for this type of therapeutic approach is to reduce the number of cancer cells in the body with an autologous stem cells transplant, so that the donor stem cells have a small number of cancer cells to attack. The following allogeneic transplant is key as the graft vs tumor effect is essential. The graft recognizes remaining cancer cells as foreign and attacks them.   If all you get is an autologous transplant, relapse will always occur.  In this study nearly 60% of patients had a complete response.  The problem?  GvHD occured in 40% of patients with a 17% mortality.  In these types of transplants GvHD is hard to prevent even with pretreatment meds.  Depends partly on how good the match is.  At any rate it could be worth discussing with your doc or looking into a clinical trial. Do you have a major transplant center near you?  Here is the reference for your review.

Maloney DG, Molina AJ, Sahebi F, et al. Allografting with Nonmyeloablative Conditioning Following Cytoreductive Autografts for the Treatment of Patients with Multiple Myeloma. Blood. 2003;102:3447-3454

Good Evening ONCRX;

"The cancer stem cells are already there, they dont come from a transplant." 

But my understanding is that the HIGH DOSE MELPHALAN is being administered to try and kill off the cancer cells lurking in my bone marrow. Then the Drs. take my stem cells for a future transplant. Is this not the case?

"Depends partly on how good the match is." 

My brother is an "A" match. But I am still concerned with Graft vs Host. However, it sounds as though the younger you have this done the better your chance of survival.

I am being treated at the Hospital of The University of Pennsylvania in Philadelphia. Approximately 2.25 hours away. But also locally for the easy stuff.

Since your last post I did some research and located this for your review:

www.professional.cancerconsultants.com/print.aspx?=37175

It speaks about tandem transplants and also supports what you mention that only allo-SCT is potentially curative. Also the major limitation to allo is the higher rate of mortality due to GvsHD.

Thank you for your timely response;

Kevin

Kevin

The HD preperative treatment is to kill off as many cancer cells as possible, but according to the article we have been discussing, the cancer stem cells are resistant to this treatment.  So even if you kill off all cancer cells, the cancer always returns because you didnt kill the stem cells.  Thats the theory anyway. 

Donor matches depend on HLA markers.  For adult donors, most places  require a match of at least 5 of these 6 HLA markers. Even this cannot eliminate GvHD, but it does reduce the possibility.  The younger you are the better your chances of dealing with the chemo, the transplant and the possible GvHD.

 

On 2/8/2008 Oncrx wrote:

Kevin

The HD preperative treatment is to kill off as many cancer cells as possible, but according to the article we have been discussing, the cancer stem cells are resistant to this treatment.  So even if you kill off all cancer cells, the cancer always returns because you didnt kill the stem cells.  Thats the theory anyway. 

Donor matches depend on HLA markers.  For adult donors, most places  require a match of at least 5 of these 6 HLA markers. Even this cannot eliminate GvHD, but it does reduce the possibility.  The younger you are the better your chances of dealing with the chemo, the transplant and the possible GvHD.

Good Evening ONCRX;

You're losing me! Are cancer cells different then cancer stem cells?

My understanding is that all cells are formed in the bone marrow. They mature into reds, whites or platelets and then leave the bone and float around the body performing their assigned duries. The cancerous ones are just cells that have not matured into one of the three and reproduce like crazy. Are not stem cells just immature normal cells?

The transplant they're discussing in the article is a tandem. My understanding from some trials is that you should have a remission from an auto before being selected for a tandem. Why would the researchers not want to try a tandem as a first line of defense?

Take care;

Kevin

I was drawn to this discussion list while looking for information on ampullary cancer (which my husband has). If it helps, I'd like to share this: My mother is going to be 69 in March 2008. In 2006 she was diagnosed with MM and underwent a stem cell transplant in December of that year. She has been in remission for over a year now. Yes, she has some associated problems: neuropathy, fatigue, and her immune system is still not very good. But, she goes to choir practice, sings in her concerts, goes to church, and basically lives her life--although somewhat more slowly than before. This is an insidious disease and many people do not live long after diagnosis. But there are also people like my mom who have managed to beat the odds (so far!). I just thought this might help some of you who are sturggling right now. Good luck to you all!

Thanks Tess -- its great to hear good news about mm patients!!  Well done to your mom and her transplant!  Best wishes for the future, Cath