What is neutropenia and how long does it last? What is a neutropenic diet?

[Music] what is the chemotherapy used during a transplant the major drug that we use in stem cell transplant is a drug called mal flan which is a very old drug it is related to a wartime chemical you know it just used to actually kill people called nitrogen mustard and this agent basically attacks the DNA myeloma cells or the plasma cells and makes the DNA molecules that are two strands they form cross linkages between the strands which basically destroys the function of the DNA and leads to cell death and this drug turns out to be one of the most effective drugs in myeloma even when we have all these new therapies it still remains a very effective drug you know in myeloma the concept is that everything that's effective has to be used at some point in during the person's lifetime with myeloma so if you miss out on a drug you missed out on the benefit from that drug which could sometimes be measured in years for example so mal flan is the drug of choice for transplants in myeloma we find that 98% of transplants in America are done with this one drug as a single agent in the old days we also used to do poor body variation along with mouth flanks but turned out that that was not necessary because mal flan alone was good enough and whole body radiation had a whole host of side effects which was not acceptable for the most part you know we have had high-dose melphalan as the primary chemotherapy that we give before autologous stem cell transplant in fact the term transplant is kind of a misnomer what we're really trying to do when we give the transplant in myeloma is give high doses of Mel filler and because man Philon is one of the most effective drugs we have against myeloma but as a consequence of giving high-dose melphalan patients develop milo suppression so their blood counts can code really low and stay there because the stem cells get killed and damaged with high-dose melphalan so collecting stem cells and giving them back is a way of countering that effect of melphalan what is the dose of milf-y and given during transplant we use a high dose of 200 milligram per meter squared for most patients for all patients or patients with kidney dysfunction or comorbidities where we think they may not tolerate the 200 milligrams we cut the dose to a hundred and 40 milligrams doses higher than that have been studied like two to eighty people have also looked at adding other chemotherapy drugs to the melphalan or using other methods to condition the patient like monoclonal antibodies targeted with radiation but those are all experimental at this time so the standard conditioning regimen is still Mel flan at various doses and that's what's used at most centers what are the alternatives to high-dose melphalan there have been other clinical trials that have combined proteasome inhibitors like bortezomib and carfilzomib as well as old-fashioned chemotherapy drugs like blues Musil fan with mel Fallon to show that there is an increased depth of response and there is a suggestion that compared to historic data that those kind of preparatory German strategies may actually result in better progression-free survival for patients in fact MD Anderson did a randomized trial comparing mph aligned with boom alpha Lang in myeloma patients both frontline newly diagnosed patients as well as patients who are in the real lab settings increase progression-free survival benefit for myeloma patients so those are some of the options if a patient walks into the clinic today what will be the standard of care regimen it would still be Mel Finland there are some other novel therapies in the pipeline that may be considered there is the son of Mel Phelan called Mel shufen which has been looked at in relapsed myeloma patients in low doses I think the company is considering giving high doses of Mel fluffin with the caveat that perhaps it will be better tolerated than Mel felon and may not have as many side effects [Music] you