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Long-term Outcomes of Autologous Transplantation in Multiple Myeloma – Part Two

Home/Long-term Outcomes of Autologous Transplantation in Multiple Myeloma – Part Two

Long-term Outcomes of Autologous Transplantation in Multiple Myeloma – Part Two

If you didn’t get a chance to read my post on Sunday, please scroll down and view the first of my two part report about this new SCT multiple myeloma survival abstract from the Czech Republic. Here are the discussion and conclusion sections of that study:

Discussion

Long-term follow-up studies of high-dose therapy with single[14] or tandem transplantation[15] show that approximately one third of patients with MM are alive at 10 years after transplantation. We have confirmed these data; in our group of 185 patients, 43% of them are alive, with a median follow-up 8.6 years. Although autologous transplantation in not curative in myeloma, this therapy brings significant benefits to the patients in terms of prolongation of their survival and improved quality of life.[16]


Many variables have been reported to influence TTP and OS after autoSCT. Advanced age has been shown to be a negative prognostic factor in some studies using autoSCT for MM.[17,18] On the other hand, other authors did not confirm its predictive significance and do recommend autoSCT in MM patients aged ≥ 65 years.[19,20] In our group of patients, age was not a statistically significant factor for TTP or OS, although there was a trend toward longer TTP and OS in younger patients.


It is not completely clear whether the achievement of CR after transplantation affects OS.[16] Results of some studies show better outcome for patients achieving CR,[21,22] whereas others do not.[7,23] The most important difficulty with evaluating the contribution of CR to the outcome of various patients is the differential impact of disease biology on the attainment of CR and response duration.[16] However, it has been published that the quality of posttransplantation response, notably CR, is significantly associated with the prolongation of TTP and OS in newly diagnosed patients with MM.[24] In our cohort of patients, patients with CR after transplantation had significantly longer TTP and OS than patients with lesser responses (P<.001).


Because autologous transplantation is not curative in myeloma, the use of various posttransplantation maintenance therapies to prolong the duration of disease control is logical, but the benefit of these strategies is unclear.[16] An exception is the maintenance therapy with low-dose thalidomide, which probably does improve survival.[25] We have compared 2 types of maintenance therapy— IFN-α alone and IFN-α alternating with dexamethasone—but no statistically significant differences in TTP or OS were observed.


The majority of patients with autografted myeloma eventually experience relapse.[14,15] The salvage therapy approaches used in patients with relapsed disease include newer agents such as thalidomide, bortezomib, or lenalidomide and conventional approaches such as combination chemotherapy or repeat high-dose chemotherapy.[16] In our retrospective analysis of relapsing disease, patients treated with regimens containing bortezomib or thalidomide had significantly longer survival than patients treated with conventional chemotherapy only. Relapsed patients treated with chemotherapy and a second autologous transplantation did not have a better prognosis than the patients treated with chemotherapy only. In fact, relapsed patients treated with bortezomib or thalidomide with or without a repeat transplantation had significantly better survival than patients treated with chemotherapy only. Based on our data, we can confirm the importance of these novel drugs for the prolongation of survival in patients who relapse after autoSCT, as reported previously by other authors.[9] Further prospective studies are needed to confirm our data.

Conclusion
Autologous stem cell transplantation in combination with novel drugs-including thalidomide and bortezomib-for posttransplantation relapse is a very effective strategy in patients with MM. According to our results, the achievement of CR after transplantation, ISS disease stage other than III, and administration of novel drugs (thalidomide or bortezomib) in posttransplantation relapse were significant parameters favoring long-term posttransplantation survival.

My conclusions: Wow! A median survival rate of ten years for patients who receive a SCT and then get maintenance treatment with novel therapies, especially Velcade? Outside of University of Arkansas you don’t here about long term survival rates being anywhere near that long—especially when you consider the ten year survival rate is after transplant, not from date of diagnosis. With results like these, I think I will continue to muddle-through using Revlimid, then Velcade, then whatever else might work, buy myself a few more years, get my transplant (unless one of the other new meds works so well I can wait indefinitely) then, hopefully, live another decade or so!  But before you (or I!) get too excited about these lengthy median survival rate numbers, wait to read tomorrow’s post.  There you will find an example of a  more sobering conclusion from the Cleveland Clinic Myeloma Research Program.

Still, feel good and keep smiling myeloma patients—more and more studies are clearly showing our median life expectancies are up—and expected to rise significantly as more data emerges over the coming months! Pat