On 3/1/2008
K. C. wrote:
Good Evening Ron;
"Now to your question... We have been speaking of a patient at Yale who... could not qualify (because of myeloma load) for stem cell transplant
The only way remission can be achieved over the long term is "Allo" transplant.
In order to do a "ALLO" the patient must have a Myeloma Load (ML) under 5%and IGg under 800 if this can not be achieved the remission period will be substantally lower."
Some points you make that need to be clarified for me: The Drs. won't consider a SCT for this patient because his numbers are too high? I don't see my numbers ever getting to the ML they want yet I plan to have an ALLO or Tandem SCT possibly next year or whenever my remission period ends; Also, long term remission, can it be achieved with a Tandem SCT or only an ALLO?
Again, I want to remind you how fortunate your brother is for having someone as informed and proactive as yourself in guiding his TX. plan.
Take care;
Kevin
Kevin for the question on SCT : the reason why Myeloma load must be reduced is multi faceted.
1) the myeloma (monoclonal cells) encompasses the marrow and crowds out the marrow until its ability to produce is significantly reduced.The reason for chemo is to reduce myeloma and to restore blood production once this happens (remission) Stem cells can be collected.
2) Ideally There should be no protein "M" spike thus Complete remission and less chance of "tainted"collection
3) Chemotherapy kills myeloma : Yes but not completely when a patient is being preped for collection, During the process of stem cell collection myeloma is collected in very very small numbers. When the desired amount of stem cells has been achieved the soup mix is frozen and stored.The stem cells are theoretically "purged" of Myeloma
4) the problem is myeloma is a monoclonal cell and before anyone has multiple myeloma a breakdown of cell production occurs and the entire process developes from just one cell. A single monoclonal cell still does not mean cancer but a single monoclonal cell in the right enviroment does mean cancer. When SCT is performed only one cell will set the ball in motion.
So why do we do this?
The reason is patients with multiple myeloma have the right environment for monoclonal cell over production and the "high dose" Kills off these cells and it could take some time to "restart" production thus extending life.
In theory........ The best longterm procedure would be a sibling HLA match... There would be NO introduction of undesired cells and most importantly the alien but accepted sibling stem cells could instruct the immune system to identify myeloma as a invader and attack. This process (provided there is not GVHD) would provide the greatest results.
Tandem SCT is also a very good choice because Your stem cells will be accepted and go straight to their "home"and set up shop in a reasonably short time.The foreign stem cells will take more time to graft but these stem cells could keep myeloma in check. but the risk of the dreaded GVHD is always present.