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 |
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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