A few months back I had an opportunity to interview transplant and myeloma specialist, Dr. Ravi Vij on a Cure Talk broadcast. The topic, Pros and cons of using allogeneic (donor) transplants against multiple myeloma. I asked a number of questions about this procedure that is now discouraged for myeloma patients in most transplant centers.
While graft/host disease is always a concern, a majority of patients with certain types of lymphoma, leukemia or MDS seem to fair much better than myeloma patients. Fair much better? Translation: Survival rates for the first year have historically been far worse for patients with myeloma than those with other blood disorders.
When I asked him why, I never felt like I received a clear answer. To be fair, he did mention “the underlying disease pathology” as the primary reason. But that’s as far as it went; it was never defined.
As I mentioned yesterday, my myeloma specialist and transplant doctor, Melissa Alsina, was kind enough to drive-up to speak to our local support group on Wednesday. As the 30 or so in the audience finished asking questions about the more common autologous transplants, I was able to ask her for some specifics about lower myeloma patient survival rates following allos.
Dr. Alsina described myeloma as systemic disease; more complicated to treat than most other blood cancers. “Most myeloma patients have underlying kidney issues, even if they don’t always show-up in normal blood work.” She continued, “Patients also tend to be older; more susceptible to complications, especially in the first three to six months.”
Dr. Alsina noted that large transplant centers like Moffitt are better able to avoid complications today. She feels that a patient under 65, with no obvious co-morbidities, should have the same 5-10% first year survival rate as those with other types of cancer.
“If a patient had a good chance of being cured, it might be worth the risk. But there’s only a 10% chance of a 10+ year remission. A young patient, with a good donor match, may want to risk it.”
Dr. Alsina went on to describe how an allo transplant attacks myeloma in two ways. “High dose chemotherapy kills myeloma cells, while hopefully the donor’s new immune system can clean-up the rest later.”
As we all know, unfortunately it doesn’t always work that way. But it sure looks good on paper! Dr. Alsina is involved in a large national study using Velcade conditioning as a way to reduce Graft/host effect; focusing on high risk patients under age 65. She reports excellent preliminary results that could help make allos safer in the future.
A few additional notes from Dr. Alsina’s talk:
* She is a big fan of MRD-Zero testing. “We need better ways to track residual disease.” Dr. Alsina affirmed.
* Moffitt Cancer Center offers transplant patients a choice of inpatient or outpatient, post SCT care.
* Her Moffitt team is just wrapping-up an interesting clinical trial, combining Velcade and a yet to be approved new drug that I’ve written about a number of times, panobinostat, a histone deacetylase (HDAC) inhibitor. Apparently adding panobinostat to Velcade in patients that have become refractory helps Velcade to work again 31% of the time. That’s a great number, and should help breath new hope into a promising drug that has posted disappointing results thus far:
The next time I see Dr. Alsina will be next week for my three month check. With any luck, my year-long run of stable disease will continue. I’m not in remission, but holding steady at a low M-spike of 0.2 is the next best thing.
Feel good and keep smiling! Pat