Here is a link to a comprehensive analysis of stem cell transplant results (SCT) from the Journal of Clinical Oncology: Long-Term Follow-Up of Autotransplantation Trials for Multiple Myeloma: Update of Protocols.
Let me warn you–this is not light reading–and the conclusions are not definitive. The goal of the study is to set the stage to compare single and tandem transplant results with the use of new novel therapy agents to answer the question once and for all. As stated in the results section of the study:
… the collective impact of successive interventions during induction, consolidation, and maintenance
phases of treatment demands longer follow-up than currently practiced for survival effects to be appreciated, especially because complete response rates exceeding50%can be regularly achieved with
novel agent combinations even without transplantation.
We hope that our work will encourage other groups to update their results so that the full impact of therapeutic trial interventions can be appreciated.
To me, SCT is just the fourth major therapy option, along with Revlimid, Velcade and combination therapy, not necessarily in that order. With carfilzomib and pomalidomide looming on the horizon, I can see why setting a transplant vs novel therapies baseline/timeline is important.
However, I believe it is more important to study timing. When is it best to transplant and why? After initial maintenance, as most transplant docs insist? After first relapse? Later relapses? Or as a last resort.
Will we have more answers in the new year? Perhaps a few. But it will take many years to get this all sorted out–and even them we may discover there is little difference between approaches.
Lots to think about. Feel good, keep smiling and try not to worry about all of this! Pat