I hope everyone had a wonderful Father’s Day Weekend!
Apparently, families of multiple myeloma patients weren’t all relaxing at the beach. I often receive emails asking for my opinion about if and when a multiple myeloma patient should undergo an autologous (using a patient’s own stem cells) stem cell transplant–holiday weekend or not.
Questions related to transplant timing continue to top my “most commonly asked question” list.
This excerpt from May’s edition of Clinical Oncology should help shed some light on the subject.
The article references one of several new studies which seem to show that waiting to undergo a stem cell transplant until a patient relapses years down the line doesn’t affect the efficacy of the procedure:
Timing of Stem Cell Transplantation for Multiple Myeloma Studied
Early and delayed autologous stem cell transplantation (SCT) result in similar overall survival in patients with multiple myeloma, even in those cases where immunomodulatory therapies have been used, a new study has found.
It has long been known that these two SCT approaches produce comparable outcomes in multiple myeloma patients; however, with the introduction of several new therapies for transplant-eligible patients over the past decade—including thalidomide (Thalomid, Celgene), lenalidomide (Revlimid, Celgene) and bortezomib (Velcade, Takeda/Millennium)—the management of these patients has changed significantly, and some have questioned how, if at all, this would affect SCT in this setting. Traditionally, early transplantation has been favored because of the side effects associated with older-line therapies. However, this has changed with the advent of new, immunomodulatory therapies that are relatively well tolerated, even for extended periods.
In a study published in the March 15 issue of Cancer (2012;118:1585-1592, PMID: 22009602), an international team of researchers representing the Mayo Clinic and the San Giovanni Molinette Hospital in Turin, Italy, studied 290 multiple myeloma patients who received first-line therapy with immunomodulatory agents, which included 123 patients who had received treatment with thalidomide plus dexamethasone and 167 who had received lenalidomide plus dexamethasone prior to SCT. The 173 patients who underwent SCT within 12 months of diagnosis and within two months of stem cell harvest were considered “early” transplant patients; 112 patients who underwent SCT more than a year after diagnosis were considered “delayed” transplant patients. The study, led by Shaji Kumar, MD, was funded in part by the Mayo Clinic Cancer Center’s Hematological Malignancies Program and by a grant from the National Cancer Institute.
At the time the Cancer article was submitted for publication, 42 patients had undergone SCT. The estimated median time to transplantation was 5.3 months in the early group and 44.5 months in the delayed group. The four-year overall survival rate was 73% in both groups (P=0.3). Four-year overall survival also was comparable among those who received thalidomide plus dexamethasone (68% in the early group versus 64% in the delayed group) and those who received lenalidomide plus dexamethasone (82% in the early group versus 86% in the delayed group). In addition, the time to disease progression for the early (20 months) and delayed (16 months) groups did not differ significantly.
The authors concluded that these findings illustrate that multiple myeloma patients “have the option of delaying SCT and continuing with initial therapy if that is their preference.”
If you would like to read more, here’s a LINK back to the article.
I’m not going to debate the advantages and/or disadvantages of waiting to transplant. The point is, waiting shouldn’t hurt a patient’s chances for achieving remission. This should allow a patient and their family to focus on other factors involved with the timing of the procedure.
Doctors may refer to auto transplants as safe and “tolerable.” But it’s still a big deal. I am living with the affects of mine eleven months after I left the hospital.
I will share details about how I am still learning to live with my new, post transplant immune system tomorrow. Let’s just say it isn’t easy!
Feel good and keep smiling! Pat