Yesterday I wrote about a conversation I had Monday with Dr. Ravi Vij, Associate Professor, Department of Medicine, Oncology Division, Bone Marrow Transplantation & Leukemia Section at the Washington University School of Medicine.  The topic: Our quest to better understand high risk multiple myeloma.

Since Dr. Vij works regularly with stem cell transplant (SCT) patients, I couldn’t resist asking him a few questions at the end of the interview about a favorite subject of mine—timing a SCT.

In other words, are there better times to attempt a SCT than others. Dr. Vij’s response:

“The longer you wait to transplant, the shorter duration of remission.” “Really?” I asked. “I understood there still isn’t a clear sense of if and when a SCT works any better if performed early or late in a patient’s therapy—that timing doesn’t effect overall survival numbers.”

Dr. Vij went on to explain that, in his experience, the more therapies a patient tries, the less effective their SCT. So a newly diagnosed patient at the end of induction therapy is most likely to have the longest, deepest remission.

On the other hand, Dr. Vij echoed the feelings of my new myeloma doc, Melissa Alsina at Moffitt Cancer Center in Tampa. Both of these experts agree: Go to transplant after your first relapse.

Dr. Vij: “I have observed there is little difference in length and depth of response between patients who are first treated and those immediately following first relapse. But with each additional therapy and relapse, the length of remission is shorter.”

Dr. Vij agreed with recent literature which shows patients who are able to achieve a complete remission or response have the best chance of a successful SCT.  He also understood why a patient would want to wait to transplant if their induction (initial) therapy was working well.

I would like to take this opportunity to thank Dr. Vij for taking the time to speak with me Monday evening. I was impressed with the good doctor’s ability to move easily between the practical and theoretical. I must admit he had an profound influence on me—and my impending decision about when and how I should time my transplant.

Do I try additional novel therapies—perhaps a clinical trial—saving SCT as a last resort? (My wife’s decision of choice!) Or do I try Revlimid one more time, increasing the dose and frequency, perhaps adding dexamethasone as well—then go to SCT when my numbers are back down.

It would help if there was more clinical science to help us make these decisions, wouldn’t it? Dr. Vij admitted as much, saying “We just don’t know for sure.” He did feel strongly about transplanting sooner rather than later. Something to think about.

Tomorrow—back to high risk myeloma. Feel good and keep smiling! Pat