Should I harvest stem cells for an autologous stem cell transplant even if I’m not sure I want to have one?
Hello David- I have been reading your website since March- you are amazing. I was diagnosed in June with early stage multiple myeloma stage 1.
My doctors are pushing for a stem cell transplant which I am not in favor of at this time. They also recommend that I harvest stem cells in case I want to do the transplant in the future. I understand the reason for that but the drugs and procedures scare me.
I have been doing chemo since the beginning of June and my Serum Protein Electrophoresis M protein numbers in g/dL are:
- 5/9 – 1.76
- 5/24 – 1.97
- 6/30 – 1.67
- 7/28 – 1.10
- 8/25 – 0.81
- 9/28 – 0.55
- 10/28 – 0.62
Bone marrow was at 50% .
I have gone through 6 rounds of RVd. The last number went up a little and it worries me even though the doctor calls it stable. I would like to know your opinion of stem cell harvest for future use. Thank you for your website. Paula
Dear Paula-
Thank you for your kind words. I have linked a spectrum of blog posts I researched and written about ASCT below.
My reply to your question is multi-part so I will itemize below. I will assume:
- you are younger than the average newly diagnosed MM patient- the average age is 69.
- I am going to also assume that your goals are to live longer than the average 5-7 years with a higher quality of life.
- Lastly, I will assume that you have not suffered any serious side effects during your 6 courses of RVd. If you have, undergoing the high dose chemo of an ASCT will probably make the side effect worse.
Think myelosuppression (low blood counts) or chemotherapy-induced peripheral neuropathy aka CIPN, nerve damage.
When you say “I’ve been doing chemo since the beginning of June” I take that to mean that you did your 6 courses of RVd from June-November.
Are you undergoing maintenance therapy (revlimid probably) now that you have completed your RVd induction therapy? I ask because you have reason to believe that your m-spike will continue to drop possibly resulting in complete remission- without have an ASCT. Low-dose maintenance regardless of whether or not you undergo an ASCT.
- Multiple clinical controlled trials over the past decade or so have established that an autologous stem cell transplant (ASCT) conveys, on average, a longer progression-free survival (PFS) but NOT a longer overall survival (OS). This means that ASCT patients, on average, enjoy a longer first remission but do not live longer than MM patients who do not have an ASCT.
- Multiple studies have established that an ASCT is aggressive therapy and therefore conveys a higher risk of adverse events aka short, long-term and late stage side effects.
- Lastly, studies have confirmed that whether the MM patient undergoes an ASCT early or late, the results are the same- longer PFS but no different OS.
- To answer your question about harvesting stem cells- as you can see from 1 and 2, I’m not much in favor of an ASCT- now or later. Especially for the early stage myeloma patient.
However, you may want to have and ASCT for your own reasons. I know of little downside, few risks, to harvesting stem cells. Especially when your m-spike is low. I do encourage you to “pre-habilitate” meaning exercise, supplement, get plenty of rest, eat nutritiously, etc. If you have access to a clinic that provides hyperbaric oxygen therapy this will kick-start your bodies manufacture of stem cells.
I’ve covered a lot of information, lots of concepts above. Let me know if you have any questions.
Hang in there and good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
One of the most frequently asked question I receive is about autologous stem cell transplants- yes, no, now, later, etc. etc. An ASCT is a serious procedure with many potential risks and rewards. I will link a number of blogs posts on this topic below.
