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Discussion about multiple myeloma treatments, stem cell transplants, clinical trials, alternative medicines, supplements, and their benefits and side effects.

Aggressive multiple myeloma

by bob s on Tue Apr 06, 2010 2:19 pm

My wife who is 58 has an aggressive form of multiple myeloma with light chains and M-spikes appearing in her urine. She has had one stem cell transplant (her cells) and got a partial response. Now 3-4 months later, they want to do a second transplant. What kind of success, remission rates, and survival times can we expect with this form of multiple myeloma and the dual transplants? The plan is for her to be on a maintenance plan with Revlimid after the 2nd transplant.

bob s
Name: Bob
Who do you know with myeloma?: My wife
When were you/they diagnosed?: July, 2009
Age at diagnosis: 57

Re: Aggressive multiple myeloma

by Dr. Bijay Nair on Wed Apr 07, 2010 6:23 pm

The outcomes in myeloma differ significantly based on risk groups. There are different ways of identifying if a patient is high or low risk: for example cytogenetics, FISH, International staging system, gene array etc. Light chains or presence of m protein in urine does not by itself make one's disease high risk.

At our institution, we have used gene expression profiling to define high and low risk groups. In the low risk group, outcomes are excellent, and in the high risk group, outcomes are poor, as I have mentioned in a previous answer. It is also important to note that the rate at which someone reaches remission is not always a good predictor of survival.

Depending on what response she had, and how she handled the first transplant, it is reasonable to do a second autologous transplant and then maintenance. We have used Velcade (bortezomib) and dexamethasone in addition to Revlimid (lenalidomide) for maintenance. On an average, based on studies done before we had Velcade, thalidomide and Revlimid, the average survival was ~ 4 yrs with single autologous transplant and ~ 5 yrs with tandem transplants. With newer drugs, the outcomes are better, and results will vary depending on risk group (some of the results from our institution have been mentioned in my previous answer).
Dr. Bijay Nair
Assistant Professor of Medicine
Myeloma Institute for Research and Therapy
University of Arkansas for Medical Sciences

Dr. Bijay Nair
Name: Bijay Prabhakaran Nair, M.D.

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