Post Induction Frustration
I am from the US 60YO male and about 1 month post induction for stage 1 IgA lambda multiple myeloma with a rib/chest-wall plasmacytoma. Have FISH 13 and was classified as low-risk by my Myeloma specialist. Blood tests for IgA dropped to normal after the first round of standard quad treatment. Never had an M-spike or other symptoms, had it not been for the rib mass causing pain, probably would have been found much later. Got my bone marrow follow-up results last week and it went from 10-15% to no detectable cells. Great news! The PET/CT showed all of the multiple hot spots were now gone and the original fist sized mass was now the size of a gulf ball and had only a little uptake on PET. Again great news.
Here is my frustration, I thought this was going to mean that my oncologist would just want to continue maintenance with the Dara and daily 10mg lenalidamide and SCT was now off the table. However, he still insists that transplant is the best way to treat the remaining residual chest mass. Other options would be radiation and based on current size could cause some lung/chest wall complications, or reevaluate in 3 months with the maintenance regime.
I am opting for the 3 months, since I have 0 symptoms, no complications from either the induction or current maintenance, especially since the Dex is now gone. I do not want to receive high level chemo and 6 months to a year recovery. The transplant specialist that I saw at Hopkins during induction felt my case would not need SCT if I had a strong response to induction. My MM oncologist seems to be old school and feels even if the final test for MRD comes back as negative it does not matter. The residual chest mass calls for the SCT. Am I being stubborn on the transplant aversion? Sorry for the long post, just was feeling so up with my results until my appointment yesterday. Also know that so many here have it worse and do not want to seem like I am complaining.