Will chromosomal abnormalities go away after an autologous stem cell transplant?

Throughout this Health Tree University course, we've explored the various chromosomal and gene abnormalities found in multiple myeloma. Thanks to groundbreaking advances in science, myeloma treatment has dramatically improved, often leading patients into deep remissions. Some even achieve MRD negativity, where no myeloma cells are detected in a sample of a million cells. But here's the big question. Could these powerful treatments actually eliminate the chromosomal and gene abnormalities that were previously detected? In this lesson, we'll dive into what happens to these abnormalities during treatment. Will chromosomal abnormalities go away after an autologous stem cell transplant or any other anti-myeloma treatment? When we treat myeloma, we're using therapy, whether it be chemotherapy or immunotherapy that we use to try to destroy the cancer cells. When we have myeloma, we have different subtypes of myeloma cells, different subgroups of myeloma cells. Some of these myeloma cells might have certain mutations and others might not. The chemotherapy that we use or the treatment that we use, immunotherapy, transplant, whatever regimen we're choosing, can actually be more effective at destroying some of these subpopulations of myeloma cells. It might be more effective at destroying myeloma cells that might not have any mutations, or it might be very effective at destroying cells that have certain mutations like 17P deletion or 1Q gain or 1Q amplification or translocation of M14, any mutation. If the chemotherapy is very effective at eradicating the myeloma, then you're going to have less expression or you're going to be able to detect that mutation less. When we do tests with a bone marrow biopsy and we do a biopsy and we have the pathologist take a look at the cells to see if they find any myeloma cells, then we send part of it to see if we can find any mutations. That sample is going to determine if there's mutations based on several things. One is, did we really eradicate the myeloma? And two, did the sample that we collect represent properly what our body has? Sometimes we have a very effective therapy that completely wipes out all of the myeloma cells in our body that we can detect and we don't find anything in the biopsy and therefore we don't find those mutations anymore because you don't have any more of those cells. But there are occasions where we might still have some of these myeloma cells hidden somewhere in the body that are hard to find but they're still there hiding somewhere and might have that mutation. And that's why sometimes these mutations reappear in the future. It could be because there were a few amount of these cancer cells that were left in the body that we didn't identify or pick up on the biopsy and re-grew. Or it could be that any myeloma cell that was left in our body, as they continued to divide and multiply, developed these mutations again because myeloma cancer cells in general, including myeloma cells, have a tendency to have mutations as they continue to divide because the machinery of these cells are distorted. So having a biopsy show a mutation or not show a mutation could be a little bit tricky. If it shows a mutation, well, we know it's there. But if it doesn't show the mutation, it could be that we really cleared that subpopulation of the cancer cells or that the sample that we chose did not have that representative cell population or that the cells are hiding still somewhere but we don't have the technology to be able to detect such small amount of cancer cells. Because right now we have the ability to do next generation sequencing which can detect one in a million cancer cells or can detect a cancer cell in a million cells. But what if there's fewer cancer cells and we might not be able to pick it up and that cancer cell might have that mutation. So it's a little tricky how to interpret these results. So it's always very important that when you see this information to discuss it with your doctor and ask what does this mean? Does this mean that that mutation is gone? Does it mean that I'm in remission? Or could that mutation still be in the body? Because it could still be there. But the important thing is more to focus on are you in remission or not based on the biopsy, based on the PET scan, and based on the blood work and go with that and what the doctor recommends.