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What Should I Consider After a Stem Cell Transplant?

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Published on November 26, 2019

What can multiple myeloma patients expect after a transplant? Leading expert Dr. Noopur Raje discusses standard maintenance therapy regimens and how a person’s mutational status can impact the maintenance stage. Dr. Raje also explains what supportive care options are available, immunity risks post-transplant, and steps to take if the disease comes back. Watch now to learn more about post-transplant care for myeloma. 

This program is sponsored by Janssen Biotech, Inc. This organization has not editorial control and Patient Power is solely responsible for the content. It is produced by Patient Power.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Raje:                    

Most people who are transplant eligible will undergo a transplant, and then we will generally put patients on maintenance treatment. So, maintenance treatment is pretty standard of care now. All patients will get maintenance treatment, and the typical maintenance that most of us use is lenalidomide maintenance. So, it’s lenalidomide (Revlimid) 10 milligrams three weeks on, one week off. And we generally, will continue that up until progression.

There is a subset of patients where at least I will use dual maintenance. And that dual maintenance will be using a proteasome inhibitor along with an IMiD. That is lenalidomide with either bortezomib (Velcade) or ixazomib (Ninlaro) or carfilzomib (Kyprolis). And typically, the patients where I will use this dual maintenance are patients who have sort of high-risk cytogenetics. So, folks with a 4;14 translocation, 14;16 translocation, and the p53 mutation are the ones where I will add a proteasome inhibitor in the maintenance stage as well. So, that’s typically what’s done for patients with myeloma.

In addition to the maintenance treatment, you should be on certain supportive care measures as well, which include treatment for your bone disease. That should not necessarily stop. You either continue with zoledronic acid (Zometa) or denosumab (Xgeva) to continue to maintain bone health. You should be getting certain prophylactic medications for up to a year post transplant, specifically acyclovir because you do have a risk of shingles reactivation at that time.

 

We do start immunizing patients anywhere between six- and nine-months post-transplantation. And I would urge patients to touch base with their treating physicians or their transplant doctor so that they get optimally immunized because you have a whole new immune system, and you need to get revaccinated with some of the drugs that you had when you were young.

I think a new addition to what we do with vaccination for our patients now is the zoster vaccine (Shingrix) vaccine because this is oftentimes asked, but we are allowing patients to get the Shingrix vaccine because it’s no longer a live vaccine. It is a vaccine, which is an attenuated vaccine and can be safely given to patients with myeloma. The thing to remember though, Shingrix vaccine is—you need to two doses. It’s at least a month apart and within the six-month timeframe. So, you get one shot, and you should get the second shot within the six-month timeframe. And the duration between the two shots should be at least a month.

So, this is sort of the basic supportive care for all patients post-transplantation. If the disease comes backif and when the disease comes back, obviously, there’s a lot of different options. And I’m not gonna hone in on what the different options are, but I think this is where actually seeking out expertise in the myeloma space is critically important so that you’re hooked up with the right treatment as and when the disease comes back.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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