Pat Killingsworth Pat Killingsworth

If you relapse after SCT, should you consider trying again?

If you had an 18% chanced of success, would you consider undergoing a second autologous stem cell transplant after the first transplant failed?

One point to consider might by what the definition of “success” is.

Take a look at this review of a small, salvage therapy transplant study from this year’s ASH:

Salvage transplant safe, feasible for multiple myeloma

Shah N. Cancer. 2011;doi:10.1002/cncr.26662.

Salvage autologous hematopoietic cell transplant should be considered for patients with multiple myeloma who have relapsed after initial transplant, according to the results of a restrospective analysis.

The study included data from 44 patients with multiple myeloma who had undergone a second salvage autologous hematopoietic cell transplant between 1992 to 2008.

The patients had a median age of 55 years at the time of second transplant and had a median time of 30 months between first and second transplant.

Overall, the second transplant was well tolerated with acceptable toxicity. Twenty-three percent of patients had a grade-3 or higher nonhematologic toxicity. The median time to neutrophil engraftment after salvage transplant was 10 days and the median time to platelet engraftment was 11 days.

When examining survival outcomes, data indicated that 11% of patients achieved a complete response or very good partial response. In addition, two patients had stable disease and one had progressive disease.

After salvage transplant, the median PFS was 12.3 months and the median OS was 31.7 months.

Overall, 18% of patients had an improvement in their multiple myeloma due to the salvage transplant.

If you read this closely, the actual CR and/or VGPR number is actually only 11%.

But the overall survival (OS) number of 31.7 months is very good, since I would guess that a majority of these relapsed patients have become refractory to Revlimid and/or Velcade, making their median life expectancy much shorter without a second transplant.

My myeloma doc, Melissa Alsina at Moffitt Cancer Center in Tampa, isn’t a big fan of using auto transplants as salvage therapy.  But these numbers do point to some possible benefit for younger patients who are quickly running out of options.

This study used a very small 40 patient sample.  Hopefully larger studies are ongoing.  Improving salvage therapy numbers is literally about life and death.  We need as many weapons in the arsenal as possible to help keep us alive.

Feel good and keep smiling!  Pat