Whether you are a newly diagnosed patient or long term survivor, there is still lots of confusion over which anti-myeloma therapies should be used and when.
Let’s use this interesting, “outsider’s” look as an example of this–using stem cell transplants to treat multiple myeloma from a Website called Health Articles 101:
Autologous Stem Cell Transplant in Multiple Myeloma Cases
Can an autologous stem cell transplant be beneficial in multiple myeloma cases? The research has been very promising, and there have been a number of successes in this area in the last few years. These transplants do not use umbilical cord blood stem cells or stem cells from any donor. Instead these cells are taken from you before your treatment starts, frozen until needed, and then transplanted back into your body. After the cells are harvested you will undergo chemotherapy at a high dose, and then have the harvested cells transplanted.
Overall survival has been shown to improve after an autologous stem cell transplant for patients who have multiple myeloma, but unfortunately there is still a high rate of relapse and a progression of this disease after the procedure is completed. Further studies have shown that more than one transplant of these mesenchymal stem cells can improve the survival odds and lower the risk of relapse after treatment.
An autologous stem cell transplant does not use pluripotent stem cells, which can produce any cell type, but instead uses your own cells. These cells are very scarce in bone marrow, but they can be multiplied and have been shown to greatly increase the odds of surviving multiple myeloma. The maintenance regimen following this treatment is also important, and has an effect on the survival rates as well.
Stem cells have opened up a whole new field of medicine, and medical treatments. Stem cell treatment for heart disease is now used to treat heart attacks, angina, and other problems. Multiple myeloma does not have to mean a death sentence, because autologous stem cell transplant treatment can boost your odds of surviving this disease significantly. Clinical studies have shown that tandem transplants, and the proper maintenance medication and doses, can mean the difference between being a survivor or a victim of this disease.
Interesting. The piece is relatively accurate until the closing statement: “Clinical studies have shown that tandem transplants, and the proper maintenance medication and doses, can mean the difference between being a survivor or a victim of this disease.”
There is conflicting data about the value of using tandem transplants. Maintenance therapy is less controversial, slowing disease progression following a stem cell transplant by as much as 40%, according to the latest studies presented at the ASH meetings in December.
However, although maintenance therapy slowes time to disease progression, using maintenance has not yet proven to extend a patient’s life. Here is a link to an article I wrote while covering a multiple myeloma expert’s panel discussion about maintenance therapy: More From Friday IMF Panel Discussion About The Latest Developments In Diagnosis, Prognosis & Treatment Of Multiple Myeloma.
Here are some key points made by the experts during the Q & A portion of the program:
After a number of months of consolidation, the question becomes whether to continue a lighter, one drug maintenance therapy.
Dr. Moreau’s opinion: “Yes!” Quoting a large, 2005 study, Dr. Moreau pointed out how patients with stable disease all fared better using Revlimid maintenance. In this study, this data applied to both low and high risk patients.
I want to pause here and caution you about one thing: Terms like “success” and “all fared better” are based on something called time to disease progression, not overall survival. Those numbers may be coming in the future. But for now, improvements in progression free survival does not mean patients are living longer.
This is confusing, especially to us patients! Myeloma docs don’t seem too worried about it. For one thing, they expect the overall survival numbers to start moving up soon. For another thing–they don’t have multiple meyloma!
Danny, who I introduced to you in last night’s article, felt the same way. Looking over his shoulder, I noticed he wrote on his note pad: “Why does PFS not translate to OS with maintenance?”
Good question, Danny! I told him I will ask that question later–either in the Q/A at the end of the evening or by asking myeloma docs their opinions whenever I get a chance this weekend at ASH.
I didn’t have to wait that long. Before I or other audience members had a chance to ask questions, the panel began debating this very issue.
All were in favor of aggressive maintenance therapy with the exception of Dr. Rajkumar from Mayo Clinic. Dr. Moreau stressed the time to progression free survival was so impressive when using maintenance that he expected these numbers to soon translate to overall time of survival.
However, Dr. Rajkumar was more conservative. He felt more data was needed before using maintenance therapy as a standard of care. Why? The disappointing overall survival numbers.
Dr. Rajkumar talked about how his goal is always to extend a patient‘s life. He went on to say, “We (myeloma docs) shouldn’t be moving the goal-posts until we see survival numbers improving.”
Cost, risks and quality of life issues come into play here. I was pleased to hear Dr. Rajkumar stand-up to the rest of the panel. Why take these toxic, expensive drugs if they haven’t proven to lead to a longer life?
Like most myeloma treatment options, there is little universally accepted data supporting any specific direction or therapy. Bottom line: Even the experts are just guessing!
Welcome to the uncertain world of treating multiple myeloma! Hopefully researchers and myeloma docs will be able to tighten all of this up over the next few years.
Feel good and keep smiling! Pat