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Myeloma Cinderella: Tandem stem cell transplants exposed

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Myeloma Cinderella: Tandem stem cell transplants exposed

Before getting to our Myeloma Cinderella’s next column, suzierose asked me to let everyone know that she’s ecstatic to be attending inauguration ceremonies this weekend.  She compared it to the recent Rose Bowl trip Pattie and I took a few weeks back.  Living a new normal can be tough, but how fortunate she and we have been recently!  Have fun on your amazing weekend!

MYELOMA CINDERELLA: Tandem ASCT Outcomes:  Auto/Allo does not Trump Auto/Auto

The Bone Marrow Transplant Cancer Treatment Network (BMT-CTN) finds when it comes to tandem ASCT outcomes,  auto/non-myeloablative allo is not more effective  than Auto/Auto.

BMT-CTN 0102 is considered a benchmark ASCT study, as It meets all the criteria for being a gold standard for evidenced based medicine.  A large randomized double blind control trial. (RCDBT)

The choices in myeloma can be complex and many times there are not definitive answers.  But when it comes to ASCT, there are now more answers than questions.  The very large trial BMT-CTN had one primary objective and that was to compare PFS for tandem autologous transplants vs. auto follow by allo .

Here are the details and comments from highly regarded experts.

BMT-CTN 0102  a very large multi-center trial involving over 700 patients in 37 treatment centers across the nation.This study found that  the 3 year PFS for tandem auto/auto vs. auto/allo  was  46% and 43%, respectively and there was no difference in OS at the 3 year follow up. Within 3 years 46% of patients in auto/allo had Grade 3-5 adverse events and 42% of auto/auto experienced the same.

Dr. Krishnan a co- principal investigator and lead author remarked, OS at 3 years was 80% in the auto-auto group and 77% in the auto-allo group. The corresponding progression and relapse rates were 50% and 46%.  However, it was the difference in mortality of 4 and 12% respectively which was significant.  Dr. Krishnan, pointed out and  concluded that the risk does not outweigh the benefit for auto-allo.

Dr. Angela Dispenzieri from Mayo commented: Fully myeloablative allogeneic HSCT has a reported long-term disease-free survival rate of 22% but an upfront mortality as high as 40%, making it an unappealing option in patients with standard-risk multiple myeloma.  Without  allogeneic HSCT, 80% of  standard-risk patients can survive 5 years with modern therapies including ASCT.

Patients in BMT-CTN  0102 study received non-myeloablative allo transplants.

We now have answers for tandem autos vs auto followed by allo.  In a  future columns we will discuss what this means in the ever evolving front line choices for us as myeloma patients.

ASCT has had a primary front line role as a  therapeutic choice and I am not challenging the choices ANY patient made.  Many of us with myeloma who made this choice are doing well.  My hat goes off to you!!

Whatever our choices, let’s keep thriving as that is the most important part of survival.  Living life to the fullest as best we can with the choices we have at the time is what we all do.  I respect all those choices.

As the kids say, “just statin’ not hatin”


I’m familiar with this study.  Despite having written a book about stem cell transplants, Stem Cell Transplants from a Patient’s Perspective, I’m no expert here–especially concerning tandem transplants.  My focus was on patient quality of life before, during and after transplant.

So I have as many questions as answers about all of this.  Why don’t you post some of yours now and I will re-visit the topic in the next day or two after suzierose gets back from her exciting trip to DC!

Feel good and keep smiling!  Pat