Recently, my mother is diagnosed with multiple myeloma. She had a fast progression. Within a year, the plasmacytoma has progressed to MGUS which resulted in multiple myeloma with severe bone involvement. She got a heart attack at the onset of multiple myeloma. I know that deletion of 17p and mutations of TP53 are associated with worse prognosis.
My mother has not undergone cytogenetic testing. My two sons carry a germline (not somatic) deletion of seven genes on 17p13.2. This deletion does not include TP53, but it includes MYBBP1A which is known to regulate TP53 and deletion. It is implicated in some cancers. If my mother has this deletion, what will be her treatment? She is getting ideal treatment for 17p deletion. She takes Velcade, Revlimid, and Dex with Zometa. Germline mutation makes an autologous transplant less likely to help. Can allogeneic transplantation help her? What does a germline mutation mean?
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The advantage of allogeneic stem cell transplant is that the donor stem cells make their own immune cells. They help to destroy the cancer cells that remain after high-dose treatment. It is called as a graft-versus-cancer effect. Autologous stem cell transplant does not offer the benefits of graft versus tumor (GVL) effect when healthy donor cells attack cancer cells, and they do not carry the risk of transplantation rejection due to graft versus host reaction.
They are relatively safe procedures, with low rates of complications and infections compared with allogeneic transplants. Deaths due to the transplant are approximately 2 % to 3 % in patients with newly diagnosed myeloma. In theory, one disadvantage of autologous stem cell transplant is that the transplant can potentially get contaminated with tumor cells when patient stem cells are used. However, recent studies indicate that this is not a significant problem and it is not a significant cause of myeloma relapse.
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