Here is a good, basic article about if and when to transplant in myeloma patients from this month’s BMT Infonet.org e-newsletter:
For years, few therapies showed promise for myeloma patients. But in the last ten years a new group of drugs to treat multiple myeloma have significantly prolonged survival for multiple myeloma patients. These drugs –Thalomid® (thalidomide), Revlimid® (lenalidomide) and Velcade® (bortezomib) – are often referred to as “the novel agents” and are now a standard part of most initial myeloma therapies, as well when patients relapse.
But what happens after patients complete their initial treatment? Should they wait and see what happens or consider a stem cell transplant?
“Giving eligible patients a combination of the novel drugs plus dexamethasone, followed by a stem cell transplant, provides superior results,” says Vesole. “Nearly all patients respond to the therapy, and a substantial percentage achieve a complete or very good partial remission.”
As with most cancer fighting drugs, these drugs have some side effects. Thalidomid® may cause tingling and numbness or a burning sensation in the hands and feet. Less often, it can cause blood clots. Revlimid® occasionally causes blood clots and low blood counts. Velcade® can also cause tingling and numbness in hands and feet.
Experts disagree on when to transplant patients with myeloma. Given the success of the “novel agents” in managing myeloma, some suggest waiting until the disease begins to progress before initiating a transplant. Others, like Mehta, disagree.
“The evidence shows that patients who undergo an autologous transplant early in the course of their disease have more time without myeloma symptoms and, thus, a better quality of life,” he says. He also cautions that the data is limited on how long novel agents alone will prolong survival, or what the effects are of prolonged use.
“We do know that the novel agents work well after an autologous transplant,” says Mehta.
Keep in mind articles like this are slanted/biased in favor of transplant. Just pointing that out.
Feel good and keep smiling! Pat