Sites like this one often share statistical data revealed to us through clinical studies. On the surface it seems simple enough. But things aren’t always what they seem. Let me explain.
Most all of the news in myeloma research these days confirms the OS advantage of achieving a complete response (CR). Logically this makes sense; it proves that a patient’s myeloma responds favorably to treatment.
That’s good news for me! I was able to achieve CR for almost three years following 14 months of Revlimid/dexamethasone therapy–and without needing a stem cell transplant.
SUPER! Knowing that, researchers can project that I may well live another five or six years; even longer if I’m really lucky.
That would put me in the small (but growing) group of ten year+ survivors. At six years out, I’m not there yet. But if I can manage to stay healthy and endure the year-in and year-out pounding of the chemo, statistics say I have a pretty good shot to make it at least that long.
So far, so good. But then I read study results like these. Pay special attention to the sentence I have highlighted at the end in BOLD:
One or two stem cell transplants for myeloma?
Patients with multiple myeloma can benefit from double stem cell transplantation after high-dose chemotherapy.
Researchers in France have been looking into a combination of treatments for multiple myeloma, a blood cancer. They wanted to discover the impact of giving not one, but two, stem cell transplants using the patient’s own bone marrow, on survival after high dose chemotherapy.
There were nearly 400 patients in the study, all aged under 60 years. They were assigned to either single stem cell transplant or a double stem cell transplant. Forty two per cent of those in the single transplant group achieved a complete or very good partial response as did 50 per cent of those in the double transplant group. The estimated event-free seven year survival rate in the single transplant group was ten per cent, while in the double transplant group it was 20 per cent. And overall seven year survival was 21 per cent in the single transplant group, 42 per cent in the double transplant group.
Among patients who did not have a very good partial response within three months after one transplant, the probability of surviving seven years was 11 per cent in the single transplant group and 43 per cent in the double transplant group. It looks as if going for a double transplant improves survival in multiple myeloma, especially for those who did not respond very well to a single transplant.
I first reported results from this study a few months back. I understand this is a controversial example. Whether or not docs should use tandem transplants is a topic for another time; there is still too much conflicting data. Instead, please focus on the highlighted sentence. According to this study, I would have been in the group that “did not have a very good partial response within three months after one transplant.”
Oh, oh. That’s not good! CONFLICTING DATA ALERT! CONFLICTING DATA ALERT! If you extend results out from this study–and I had transplanted back when I was first diagnosed–I most likely wouldn’t live another year.
That’s disconcerting! Making things even more complicated: I decided to wait to transplant until I was over four years out. The fact I would be unlikely to make it seven years from the time the clinical trial’s clock started ticking still puts me over the ten year mark.
WHEW! Guess I can relax for a few more years!
So what does all of this prove? Should everyone wait to transplant, then get a tandem transplant after they relapse in attempt to add a few years to their myeloma-shortened lives? I’m doubtful that’s going to catch-on!
But according to these results, it wouldn’t be crazy to consider such a strategy. Too bad my transplant doctors didn’t have this information yet. Maybe not; I wouldn’t have been happy going through all of that again! Instead, my docs felt, “Why repeat something that worked so poorly the first time?” Hard to argue with that!
Our doctors use studies like these to help formulate–and justify–the therapy choices they make for us. But you can see how difficult this can be. Mere snapshots in time, dozens of multiple myeloma studies are starting and stopping each year. All feature different goals and qualifications for their test subjects, making it nearly impossible for our doctors to make reasonable, rational real world decisions for their patients; one reason why conservative physicians like Mayo Clinic’s Vincent Rajkumar sit back and wait for the dust to settle.
Prudent, but it can take years–even decades–for myeloma experts to sort through all the data and form a consensus before making major therapy shifts. Frustrating, but the only way to proceed safely and in the patient’s best interest.
Tandem transplants are in; then they’re out. Should patients be treated incrementally–in drips and drabs–or hit them hard with everything up-front?
Add the challenge of trying to match the best therapy to an individual patients age, myeloma stage, cytogenic test results and/or co-morbidities and I have just made the best possible argument for why myeloma patients need to seek-out a specialist at one of the major cancer centers. This stuff is way too complicated for a medical oncologist to analyze and sort through. They simply don’t have the experience or the time.
And one more piece of advice: Try not to read too much into news you get from an ongoing study–at least until you read the fine print. Focus on trends, not day to day results; the same way investors should (but often don’t!) watch the stock market.
I’m busy writing and editing several exciting new posts this week. Another installment of my new series about complimentary medicine, Danny Parker’s ongoing exercise expose’ and news about some new medical challenges I’m facing. Never a dull moment! And I wouldn’t want it any other way.
Feel good and keep smiling! Pat