In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?
We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to achieve VGPR or response prior to collection? Any preference on KPd versus DPd or alternative regimen?
Answer from: Medical Oncologist at Academic Institution
In fit patients with less than a partial response to induction therapy, i.e. primary refractory, the optimal timing for stem cell collection is NEVER. If they don't respond to three drug induction (proteasome inhibitor + IMiD + steroid), they are unlikely to respond durably to a standard high dose ...
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Medical Oncologist at Huntsman Cancer Institute, University of Utah Thank you for the response. In follow-up to this q...
Answer from: Medical Oncologist at Academic Institution
I will take a different tactic in these primary refractory disease cases.
I typically employ a VD-PACE like regimen and give for 2 cycles. Then use the second cycle as part of chemomobilization for stem cell collection, followed by high dose melphalan and stem cell rescue. After transplant, I then ...
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Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center Agreed completely re: CAR T, although, definitely ...
Medical Oncologist at University of Chicago Desperate times call for desperate measures. We ca...
Answer from: Medical Oncologist at Academic Institution
Adding an updated response as requested by theMednet editorial team :) I agree with everything in @Craig C. Hofmeister's response from 3 years ago. For patients with primary refractory myeloma, even collecting stem cells is probably low-yield especially since it's not benign. And while continued len...
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Medical Oncologist at Clinical Instructor Out of curiosity @Rahul Banerjee, I've heard there...
Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center Excellent point @Anthony C. Bejjani, and I couldn'...
Thank you for the response. In follow-up to this q...