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Is A Stem Cell Transplant The Best Anti-Multiple Myeloma Therapy After First Relapse?

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Is A Stem Cell Transplant The Best Anti-Multiple Myeloma Therapy After First Relapse?

Yesterday I began to describe the anti-myeloma strategy I expect to use once my multiple myeloma returns. As my myeloma slowly (very slowly, thank God!) begins to creep back, I am facing a number of important choices. Do I increase my Revlimid dose and frequency—then add dex to try and knock the cancer back again? Yes! This is an easy decision. If and when that works—and I expect it will—what then?

A) Do I try Velcade? B) Join a clinical study using one of the new novel therapy agents, alone or in combination? Or C) Do I reluctantly undergo a SCT?

Until recently, I would have guessed A or B. That is, until I moved to Florida and started seeing my new myeloma specialist, Dr. Melissa Alsina.

Dr. Alsina is a young, up and coming myeloma doc. I was surprised to see her name prominently displayed as part of several important research studies in Chicago at ASCO last month.

Dr. Alsina believes if you wait to transplant after your initial relapse, you are risking a less effective SCT. Her advice: If and when my multiple myeloma becomes more active, knock it back down and go to transplant—end of story.

I considered this option—then decided to stick with my original plan: Delay using a SCT until it was my last and only option.

Recently I ran a three part series interview series with Dr. Raji Vij, Associate Professor, Department of Medicine, Oncology Division, Bone Marrow Transplantation & Leukemia Section at the Washington University School of Medicine. One of the articles was titled: The Best Time To Get A Stem Cell Transplant For Most Multiple Myeloma Patients: After First Relapse.

I was impressed with Dr. Vij. The interview had a lasting impact on me. His bottom line: There better times to attempt a SCT than others. “The longer you wait to transplant, the shorter duration of remission.” In Dr. Vij’s experience, the more therapies a patient tries, the less effective their SCT. “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.”

I recommend you click on the above titled link and read or re-read my interview. Let me pause here and note I have yet to find any research data supporting Dr. Alsina’s and Dr. Vij’s position. But I must admit, when two myeloma specialists from opposite sides of the country share the same philosophy, it makes an impact. It certainly did on me!

Tomorrow: Why not go to SCT after first relapse. Feel good and keep smiling! Pat