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Plasma Cells Cause ASCT Relapse?

Multiple Myeloma Stem Cell Transplant
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The purpose of an autologous stem cell transplant is to kill the MM patient’s myeloma cells (plasma cells growing out of control) and then replace the MM patient’s immune system with a new one. This is necessary because when all that chemo killed the bad plasma cells (MM) is also killed the good red, white blood cells and platelets.

The standard-of-care therapy plan for multiple myeloma is

  • Induction Therapy
  • Autologous Stem Cell Transplant
  • Low-dose Maintenance Chemotherapy

All of this chemotherapy is given to the MM patient for the purpose of killing the patient’s out-of-control plasma cells (MM cells).

The problem, if I understand the study below, is the presence of plasma cells IN the “autograft.” The autograft is the harvested stem cells taken from the MM patient before he/she has an autologous stem cell transplant.

For the record, all ASCT procedures are the same. The same stem cell harvest, the same chemotherapy regimens, the same dosing, the same everything.

The FDA says so.

What are plasma cells? The second link below is the most comprehensive and easy to understand explanation of plasma cells that I could find. If you want to understand your cancer, how plasma cells cause multiple myeloma, I suggest you read the linked info below.

I believe there are two key takeaways here-

  1. Minimal Residual Disease is the goal. If the patient reaches MRD status after only induction therapy, there is no need, no benefit for that patient to undergo more toxicity aka more chemotherapy and
  2. Almost by definition, an autologous stem cell transplant is often problematic. There will always be the chance that harvested stem cells contain plasma cells (myeloma cells) that, if given back to the MM patient, will multiple and cause the patient to relapse. 

The key issue for all myeloma patients is…plasma cells. Read the posts below to learn more about plasma cells and multiple myeloma. 

Have you been diagnosed with multiple myeloma? Are you considering an autologous stem cell transplant as part of your therapy? Scroll down the page, post a question or comment and I will reply to you ASAP.

Good luck,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Clonal Plasma Cells Are a Predictor for Worse OS After AHSCT in Multiple Myeloma

“According to a study published recently in Blood Cancer Journal, clonal plasma cells (CPC) present in the donor graft are predictive of worse overall survival (OS) after autologous hematopoietic stem cell transplantation (AHSCT) in patients with multiple myeloma (MM)…

In AHSCT, healthy marrow is stored and given back to the patient later. Many patients who receive AHSCT eventually relapse, and researchers at the MD Anderson Cancer Center believe the reason is residual CPCs in the autograft…

Oren Pasvolsky, MD, and coauthors conducted a retrospective review of their institutional database to determine whether there was any correlation between the presence of CPCs in the autograft and survival outcomes.

Using next-generation flow cytometry (NGF), the researchers identified 75 autografts with residual CPCs and 341 with no residual CPCs at their institution between 2008 and 2018. With this sample, they were able to determine that “The CPC + group was less likely to achieve [minimal residual disease (MRD)]-negative complete remission post-transplant…”

The study reported progression-free survival (PFS) and OS outcomes for both the CPC+ and CPC- groups.

The CPC- group had a median PFS of 32.1 months versus only 12.8 months in the CPC+ group. Similarly,

The CPC- group had an OS of 81.2 months, significantly greater than the 36.4-month OS in the CPC+ group.

These results led the authors to conclude that “the current study shows a major impact of CPC in the autograft on post-autoHCT outcomes in HRMM.” The authors suggest that “Novel strategies for purging of CPC could improve patient outcomes…”

The plasma cells

“Multiple myeloma is a cancer of the plasma cells, a type of white blood cell that makes antibodies. Multiple myeloma is a hematological, or blood, cancer because it affects blood cells. Plasma cells are found in bone marrow, where blood cells are made. Normal bone marrow contains few plasma cells. A person with multiple myeloma often has many abnormal plasma cells (myeloma cells) in the bone marrow…

In multiple myeloma, B cells don’t work properly and make many abnormal plasma cells (called myeloma cells). Normally, plasma cells make up about 2%–3% of the cells in bone marrow. In people with multiple myeloma, abnormal plasma cells make up at least 10% of the cells in the bone marrow. They crowd out (take the space of) other types of blood cells, such as red blood cells, other white blood cells and platelets, so there aren’t enough of these cells to do their jobs…

When B cells develop into abnormal plasma cells (myeloma cells), they make large amounts of one type of immunoglobulin (called a monoclonal immunoglobulin) and release it into the blood. This monoclonal immunoglobulin is also called an M-protein or paraprotein. An M-protein can be measured in the blood and urine. If a lab test finds an M-protein, there is a problem with the plasma cells…

In multiple myeloma, myeloma cells stop osteoblasts from making new bone. Myeloma cells also make osteoclasts work harder to break down bone, so bone gets weaker. Osteoclasts also make chemicals called cytokines that stimulate myeloma cells to grow and divide.

The combination of myeloma cells collecting in the bone marrow and osteoclasts breaking down bone causes it to become weak and thin. Areas of bone weakness can be seen on an x-ray as thin, dark lines called fractures or dark circular spots called osteolytic lesions. Osteolytic lesions may mean that there is a plasmacytoma or other disease of the bone. Weakened bone may break under normal stresses like walking, lifting and coughing. Thinning of the bone can also lead to osteoporosis…”





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