I have some good news to share with you. I had a PET CT at the very end of February to see how the new chemotherapy regimen is doing, and it was clean. This means that no metabolically active tumors were seen. The bone destruction caused by the tumors is still visible, of course. However, even this seems to healing a little. This is great news! I guess technically you could say that I’m in remission for now.
There’s a funny thing about allogeneic transplants. The patient must be in remission at the beginning of the transplant. You may ask yourself, “why would you DO an allogeneic transplant if the patient is in remission?” Well, we know that myeloma WILL come back, but we don’t know when. So think of the remission as temporary. That’s the reason to go ahead with a transplant, especially in a younger patient, when the risk/ benefit calculation tips to the side of benefit.
Now, why couldn’t you go ahead with a transplant in the presence of metabolically active tumors? There is a period of time after the transplant, lasting weeks to months, when there is no treatment against the myeloma – no chemotherapy, no immune system. No chemotherapy is given because that would interfere with the establishment of the new immune system. My immune system is offline during this time, and the new immune system from the donor hasn’t kicked in yet. It’s like that scene in Star Wars at the end where the defense shields are down. Eventually the new immune system from the donor will grow and take over and kick the myeloma in the butt, but that takes a while. So during this vulnerable window the myeloma cells can grow unharassed, unchecked. Clearly then, it’s incumbent to have the myeloma activity at the lowest level possible at the beginning of this whole process.
If a donor becomes available, but there IS metabolically active myeloma, there are intense things that can be done to the patient to knock the myeloma down right before the transplant – usually some combination of radiation and heavy-duty chemotherapy. However, this also serves to weaken the patient right before they are going into the fight of their lives, so obviously it’s much better if that does not need to be done.
Hopefully my stars are about to be aligned!