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Spine fracture, plasmacytoma, multiple myeloma. Undergoing chemotherapy. Suggested stem cell transpalnt. What will be the best decision?

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Practicing since : 2004
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Hi Doctor,
This is Regarding my Mother. She earlier had Plasmacytoma which progressed to Multiple Myeloma. I have asked questions and uploaded reports earlier and Dr. Indranil replied with his advice which guided us alot. She had fracture in spine which was treated with kyphoplasty and last skeletal survey revealed some small leisions in skull and decease was considered as Multiple Myeloma. She is currently undergoing Chemotherapy (Bortezomib-Dexamethason). 2 cycles (with 4 injections\cycle) are completed and 3rd cycle is going on. We got SE test done after completion of 2nd cycle which revealed M-spike to be 0.86gm\dl that is much reduced as compared to last SE report, that was done before starting of chemotherapy (where M-spike was 3.02 gm\dl). Doctor here are suggesting for Stem cell trasplant. They are leaving the decision on us and have said that she may go with stem cell transplant after M-Spike reduce to 80% from its current value which is 0.86 gm\dl. But, my Mother does'nt want to go with Stem cell Transplant as she fears from its side effects and doesn't wants to reduce the quality of life because of its side effects. Please give us best possible decision at this time as we are really confused for next step after chemotherapy.

Thanks and Regards, XXXXXXX XXXXXXX
Posted Mon, 2 Jul 2012 in Cancer
 
 
Answered by Dr. Indranil Ghosh 51 minutes later
Dear Mr XXXXXXX

It is nice to hear that your mother is doing well on treatment. Stem cell transplant is a good option in myeloma but it is actually nothing more than a cycle of high-dose chemotherapy followed by rescue by one's own stem cells. It helps in controlling the disease longer than drugs alone. However, myeloma is incurable as of now and even stem cell transplant cannot cure it.

However, it is still considered a standard treatment in patients less than 65 who are fit. The mortality is around 2% in expert hands. There is a growing notion that in this era of novel drugs there may not be a survival benefit for transplant (because many options are available for second/third line treatment after relapse).

If she is fit enough and willing to have a bit more side effects for a longer duration of control after first line therapy, I would recommend transplant, after 4 cycles of current therapy.

I will be happy to answer any further queries. If my answers have helped you then please take some time to give your feedback on the site.

Best wishes,
Indranil
Above answer was peer-reviewed by
 
Follow-up: Spine fracture, plasmacytoma, multiple myeloma. Undergoing chemotherapy. Suggested stem cell transpalnt. What will be the best decision? 4 days later
Hi Doctor,

3rd Cycle of chemotherapy is completed and she is having side effects of same. Following are the side effects she is facing :
1.) There is pain & numbness in legs and feets (increased after 3rd cycle)
2.) Full body swelling (Early morning). Reduces as the day passes.
3.) Tastelessness in mouth.
4.) Weakness (more in feets). Earlier she used to go for morning walk. But now she finds hard to walk like before.

She is taking Aciclovir Tablet (Twice a day) and Dekdak 20mg (Only once on next day of every chemotherapy).
Please suggest what medicine or diet can be taken to reduce side effects and weakness.

Thanks & Regards,
XXXXXXX XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 5 hours later
Dear Mr XXXXXXX

These are side effects of treatment.
Weakness and swelling may be due to low Hb; check it and if low- blood transfusion will be required.

Pain and numbness are due to bortezomib, a dose reduction may be required.
She can also take pregabalin tablets for the same, please consult her doctor.

I hope you understand that exact drugs and doses can only be prescribed by treating physician.
Above answer was peer-reviewed by
 
Follow-up: Spine fracture, plasmacytoma, multiple myeloma. Undergoing chemotherapy. Suggested stem cell transpalnt. What will be the best decision? 5 days later
Dear Doctor,

I appreciate your valuable suggestions.

The latest report of Serum Electrophoresis, KFT, CBC is attached. This time report says No M-Spike seen. As if now my mother is not favouring for stem cell transplant as it require high dose of chemotherapy prior, which has major side effects. There fore I would like to know what are the chances of M-Spike to appear again if we wait for now. Please suggest for further course of action. Does she require stem cell transplant now or we should wait and can just take medicines.

Thanks and Regards, XXXXXXX XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 8 hours later
Dear Mr XXXXXXX

The reports are all fine. It is good that no M spike is seen.

At this point if she is not willing for transplant, I would give one more cycle of bortezomib-dexamethasone and then put her on thalidomide as maintenance therapy. However, this part is my personal preference and if somebody just puts her on observation that is also fine. Zoledronate should continue for 2 years.

Eventually she would relapse; the duration of remission can't be predicted.
There are many other drugs which can be used on relapse.

Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Spine fracture, plasmacytoma, multiple myeloma. Undergoing chemotherapy. Suggested stem cell transpalnt. What will be the best decision? 47 hours later
Hello Doctor,

We visited the treating physician and shown Last SE report (No M-spike). He has advices for Serum Free Light Chain test (Sample for which is already given, report is awaited). Also he is not recommending for 4th cycle, as if now. However, asked to visit after one week with Free light chain report. After which he said that, he may be putting her on drug Lenalidomide which as per Doctor has less side effects compared to thalidomide.
Zoldria will continue with monthly frequency.

Doctor we are not aware of Stem Cell transplant and its risks to life. I want my mother to go for stem cell transplant as she is health wise fit. But, don't want to take a chance as far as expert hands are concerned. Please suggest for Best Doctor in this country or in Delhi\NCR area, who has done 100% successful stem cell transtplants on Myeloma patients.

Thanks & Regards,
XXXXXXX XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 3 hours later
Hi again,

Stem cell transplant has 2% life risk even in expert hands. There is nobody in the world who has done sizable number of transplants and yet had not encountered any mortality. But still based on number of transplants AIIMS is definitely the largest and most experienced. If you are looking in the private sector then you can consider Dr XXXXXXX Bhargava at Medanta.

Lenalidomide maintenance is certainly an option but I would rather keep it as a reserve for second-line therapy. Thalidomide in low doses as maintenance is also quite safe. Free light chains can certainly be used for monitoring.

Regards
Above answer was peer-reviewed by
 
Follow-up: Spine fracture, plasmacytoma, multiple myeloma. Undergoing chemotherapy. Suggested stem cell transpalnt. What will be the best decision? 3 days later
Hello Doctor,

We've just received the reports for Serum Free Light Chain. Reading appears to be in normal range. I've uploded same, please have a look.
1) I know that the problem is incurable, But Is there a possibiliy of M-spike to not appear again?
2) Does disappearing of M-Spike represents plasma cells to be in normal range in Bone marrow?
3) How long does the numbness and pain in feets (because of side effects of chemotherapy) usually takes to go?

Thanks for your valuable advices,
Regards,
XXXXXXX XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 16 hours later
Dear Mr XXXXXXX

As of now she had attained a complete response. In all probability plasma cells in bone marrow are within normal limits now. Thus we can hope for a long term remission.

However, if she lives sufficiently long, M spike would certainly reappear. But there are many drugs available now for future treatment.

Numbness may take 2-4 months to resolve.

Regards,
Above answer was peer-reviewed by
 
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