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Thoughts About Timing A Stem Cell Transplant

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Thoughts About Timing A Stem Cell Transplant

For those of you who didn’t see this, I wanted to share these excerpts from a Cure Magazine/Reuters article about timing a stem cell transplant:

With new induction drugs for multiple myeloma, still OK to delay stem cell transplant

SEPTEMBER 16, 2011

NEW YORK (Reuters Health) – In patients with multiple myeloma treated initially with new immunomodulatory drugs, delaying stem cell transplantation won’t affect overall survival, a new study shows.

The study’s results, the investigators say, underscore the idea that stem cell transplantation should be considered an independent therapy regimen and not a “platform” on which chemotherapy is based.

Stem cells need to be collected early, however, even when transplant will be delayed. “This is very important,” the researchers say, because there’s an increased risk for collection failure with longer use of some newer induction agents.

Before the modern immunomodulators were available, studies showed that doing a stem cell transplant (SCT) immediately after alkylator or steroid-based induction therapy, or delaying it, led to comparable outcomes.

But “there are several potential concerns about extrapolating the previous data in the context of current regimens,” said Dr. Shaji Kumar, the study’s lead author, and his colleagues in their report. “In particular, it is not clear whether patients who relapse after newer therapies will be able to obtain a meaningful response from high-dose melphalan and whether patients will be losing the ability to benefit from an effective treatment modality like SCT.”

“It is one of the most important questions we face today, whether we are gaining anything by using up all that we have right away, since all myelomas will eventually get resistant to all drugs,” Dr. Kumar, from the Mayo Clinic in Rochester, Minnesota, told Reuters Health in an email…

…The decision to delay SCT can be based on a number of factors, including the patient’s response to induction, any toxicities, and physician and patient bias. In general, however, the newer immunomodulatory drugs, with their better efficacy and lower toxicity, have led to longer delays between induction and SCT, according to the researchers…

There is much more. Click-on this LINK to access the article.

Looks like those of us who believe that waiting to transplant until after first relapse should be presented as an option for newly diagnosed patients are beginning to be heard. We’ve made enough progress to be included in mainstream discussion!

Now it’s up to researchers to fill-in the blanks to help newbies make a careful, measured decision. Should I harvest now and wait to transplant, start induction and proceed immediately to SCT–or opt for an even more aggressive approach and consider tandem transplantation.

Just as important, at what point does a SCT lose it’s effectiveness; after first relapse? A second or third? So many questions and so little time…

Feel good and keep smiling! Pat