It was easy to become a bit discouraged as I wrote my book last year, Stem Cell Transplants from a Patient’s Perspective.
As I interviews lots of donor transplant patients, it didn’t take long to figure out that their side-effects were significant and long lasting.
But I did speak with a few that tried mini allogeneic (donor) transplants–and they seemed to be doing a lot better. My myeloma specialist, Dr. Alsina, runs the BMT Unit at Moffitt Cancer Center. So in addition to working with myeloma patients, she spends a lot of time overseeing allo transplants for lymphoma and leukemia patients, too.
Dr. Alsina has been experimenting in-house with a type of allo which falls somewhere between a mini and full donor transplant. By tweaking the high dose chemotherapy mix, she recently told me that she had significantly cut down the number of graft vs host symptoms among these patients.
Anyway, I read about promising results using mini’s in Europe this yesterday in the Myeloma Beacon. Here is the abstract from the study:
The purpose of this study was to assess the results of allogeneic stem cell transplantation (Allo-SCT) after reduced-intensity conditioning (RIC) from matched related donors (MRD) and unrelated donor (URD) in 40 patients with high-risk multiple myeloma (MM) in a single centre.
Seventeen (43%) (Group 1) and 23 patients (57%) (Group 2) had URD and MRD respectively. Thirty nine patients (98%) received one or more autologous transplantation. The median follow-up was 22 months (1-49). None of our patient experienced a graft rejection. The cumulative incidence of grade II–IV acute GVHD was higher (47%) for the URD vs. (17%) for the MRD (p= 0.092). The cumulative incidence of chronic GVHD was no different between the two groups (24% vs. 30% respectively). At two-year the TRM probabilities was lower in the unrelated group 12% vs. 22% in the related group (p =0,4).
Also at 2 years, for patients receiving unrelated transplantation overall and progression-free survivals, 59% and 42% respectively compared to patients with related donor transplantation, 66% and 44% (p= 0.241). In conclusion, these results suggest that URD in MM is feasible. The small number of patients with URD, emphasize the need to delineate indications and perform prospective protocols
© 2012 John Wiley & Sons A/S
The point of all of this is that allo transplants have often left myeloma patients and docs disappointed. Yet on paper, the concept seems so promising. I still think there is some real hope/potential here for researchers who are willing to think “outside the box.”
Another major option for us–especially as a salvage therapy–could really help to extend a lot of myeloma patient’s lives.
Feel good and keep smiling! Pat