Our newest contributor, suzierose, emailed me last night to let me know she is already working on next week’s column. She also answered the questions I had following her column yesterday:
I do have a few questions for suzierose. Does this mean low risk patients that only received the therapies described above (tandem auto stem cell transplants with or without Thalomid maintenance) are really living 8 years? Without the help of Velcade or Revlimid? Either way, this puts a pretty positive spin on things if patients using such basic therapy can live more than twice as long as I was told I would live in 2007–a short 43 months.
Here is what she emailed me last night:
What the studies show is IF you have the patient profile of those in the study, and you received that therapy you have a 75% chance of living 8 years. Note, the profile includes being younger than 55 as well. It is not an only that therapy. Rather, it is a this is what this specific therapy has demonstrated. Most importantly, the study shows what factors are associated with 8 year survival. I think a better way to put it is that it identifies cytogenetic abnormalities that will not result in 8 year survival.
“Without the help of Velcade or Revlimid?” Yes, according to the statistical analysis, if you meet all the patient profile variables. The identified variables mean you will not statistically have an 8 year survival. We are talking tandem ASCT’s with and without thalidomide maintenance.
That was news out of ASCO 12 as well, that while myeloma remains incurable in the last decade they doubled the OS rates. Were tandem’s common when you were diagnosed?
Thanks, suzierose! And no, tandem’s were not common. Their use seems to have ebb and flowed over the years. UAMS in Arkansas have always been–and still are–strong proponents of tandem autologous stem cell transplantation. Just when their use was starting to spread a bit and approach being considered a standard of care, data began emerging internationally discrediting their use. Too toxic and risky for a what was considered little or no benefit.
Before I get lots of nasty emails from UAMS supporters, let me note that Dr. Barlogie’s team would argue many of these tandems weren’t done correctly–the way they handle things at UAMS. One could also question study bias. Too toxic and risky? Reasonable. But considering European centered criticism, could cost also have something to do with it?
I have noticed a trend back toward tandems, at the same time that overall use of SCTs is falling off. Certainly 8 year survival numbers without the aid of newer drugs helps validate their use, don’t you think?
Looking back on my early “myeloma 101” education in the spring and summer of 2007, tandems were being pushed hard by UAMS. I know docs at Mayo Clinic weren’t fans. Which was a relief to me–at the time I wasn’t prepared to undergo one, let alone two!
And most mainstream myeloma centers were not using them as a planned, preferred therapy. Some UAMS “alumni” may disagree with this. But I would be surprised if more than 10% of newly diagnosed patients in the U.S. ever received planned tandem transplant therapy, regardless of their popularity at any given time.
But all of this misses the point. The fact that so many young, low risk patients could live this long without using new novel therapy agents speaks optimistically to those of us that have access to them. It also reminds us that it may be a decade or more before new, credible OS numbers begin to emerge for patients that have also had access to Kyprolis (carfilzomib) and POMALYST (pomalidomide), let along MLN9708, ARRY-520, elotuzomab and a half a dozen other promising new myeloma therapies.
Guess we need to live that long so we can see what happens!
Feel good and keep smiling! Pat