Here is part of an interesting blog post from a retired oncologist, Dr. Herman Kattlove, titled “I was wrong – transplants work for multiple myeloma:”
… Over the last 10 years, treatment has improved. During most of my practice years, the main treatment was a pill called melphalan. It didn’t cause many side effects and often the disease would remit for a while – maybe even a few years. But it always came back and there wasn’t much we could do at that point.
Then someone came up with the idea of giving these patients high doses of melphalan intravenously. This would normally kill them because although most of the myeloma cells in the bone marrow would be wiped out, the good ones responsible for making white cells, red cells and platelets would also take a hit. To get around this, normal bone marrow cells would be collected from the patient beforehand and then given back after the treatment.
Of course, some myeloma cells would get in there also and that was my problem with the procedure. Myeloma cells were being returned and so there was no question that the myeloma would come back. And it did. But, what I failed to realize was the fact that myeloma is generally slow growing so it took a long time for the disease to reappear. Then the researchers began adding a second transplant – same procedure – a few months after the first. I really doubted that all the pain of the high dose chemotherapy and transplant were worth it.
But, I was wrong. This month, in the March 1 Journal of Clinical Oncology, the myeloma transplanters presented their results after over ten years of different trials of high dose chemotherapy and transplants. And the results look great. The most recent trials are reporting their patients surviving much longer, with half alive after 10 years. When I was in practice, I would have considered it a miracle if any patient lived 10 years. And now, at least half are? Wow!
Some issues. One reason survival has improved is that there are new drugs around that can be used when the myeloma comes back, which it inevitably does. But the drugs keep the disease in check for a while longer. And also, the studies favored younger patients and that is always a problem. Those of us over 65 were not big participants in these studies – maybe many of us are too sick to handle the high doses of drugs. But, nearly two-thirds of myeloma patients in the U.S. are over 65 so it isn’t clear that these results apply to everyone…
This post reminds me of a conversation I had with an older oncologist at the airport in New Orleans leaving the ASH convention last December. Nice guy! I don’t recall his name, but he too marveled at the progress medicine has made over the past ten years treating myeloma–recounting and sharing many of the same advances Dr. Kattlove shares with us on his blog. You can read this blog post in it’s entirety by going to: Dr. Kattlove’s Cancer Blog.
Feel good and keep smiling! Pat