How does Dr. Durie feel about the M.D. Anderson study I mentioned yesterday? He was skeptical, to say the least! To review, I shared with Dr. Durie the results of a 700+ patient study, recently completed by M.D. Anderson oncologists in Dallas, showing a median survival rate of 9.7 years for transplant patients in CR at the time of their transplant, vs 4.4 years of median survival for other patients. That looked like a big deal to me! More than doubling your projected life expectancy if you received a transplant while in complete response. This was especially important to me, personally, since I am in CR and my oncologist, along with another at Mayo, have both been nudging me to get a stem cell transplant sooner rather than later. Dr. Durie’s response: Like many similar studies, this one was flawed! Without prompting, Dr. Durie gave me three important reasons why. First, only patients healthy enough to travel to these large cancer centers participate in these studies. That rules out 20% of the sickest patients right there. Second, institutional bias effects the results. Finally, who is to say how long a patient in CR would survive without any transplant at all?
I was taken aback by Dr. Durie’s assertiveness on the subject. My initial impression of him had been he was very easy going and politically correct. So, how did he feel about my personal situation. “Pat, the reason a patient gets a transplant is to shock their system and bring their numbers down. Why would you get a transplant now, when you are already in complete remission?” Dr. Durie mentioned several times during our conversation that he believes in treating myeloma only if and when it is necessary, in the most appropriate way at the time. For him, my current situation does not merrit a transplant.
So what next? My two other options are to continue with my current chemotherapy using 10 mg of Revlimid 21 days a month, or stopping treatment altogether to give my body a break and wait and watch for the myeloma to return. Could be in a few months – or a few years. Dr. Durie’s recommendation? I will cover that in detail tomorrow in the third and final interview instalment.
Feel good and keep smiling! Pat