What do stem cell transplants and marijuana have in common? Nothing that I’m aware of. I simply had two important, unrelated parcels of information I wanted to get out to start the week.
Here’s hopeful allogeneic (donor) stem cell transplant data from John Theurer Cancer Center in New Jersey, published in the Journal of Biology of Blood and Marrow Transplantation:
The graft-versus-myeloma effect: Chronic graft-versus-host disease but not acute graft-versus-host disease prolongs survival in patients with multiple myeloma receiving allogeneic transplantation
Received 20 January 2014; accepted 15 April 2014
Published online 02 May 2014.
We have conducted a study of patients with multiple myeloma (MM) undergoing allogeneic transplantation to evaluate outcome parameters.
Patients and methods
Fifty seven consecutive patients with MM received an allogeneic transplantation between 2004 and 2011 at our institution. Patients who had received at least one prior autologous transplant were included. Twenty six patients underwent allogeneic transplantation for consolidation after a response to their first autograft, and 30 patients received an allogeneic transplantation as salvage therapy. Donor source was evenly distributed between related and unrelated.
The median follow-up was 52 months. Thirty two (57.1%) patients achieved a CR. At 5 years, 49.2% of all patients were in CR. Sixteen patients received either donor lymphocyte infusions (DLI) or immune suppression withdrawal for disease progression, with a 62.5% response rate. The 5-year OS for all patients was 59%. The 5-year OS for the 30 patients in the consolidation group was 82% compared to 38% for the salvage group. In multivariate analysis, 3 factors remained significantly associated with OS. These include being in the salvage group (HR 4.05, p=0.0196), acute graft-versus-host disease (HR 2.99, p=0.034) and chronic graft-versus-host disease (cGVHD) which was highly protective, with a 5-year OS of 78.8% for patients with cGVHD versus 42.6% for patients without cGVHD (HR 0.17, p=0.008).
Our data show that allogeneic transplantation for multiple myeloma can lead to sustained remissions. Acute GVHD (aGVHD) is significantly deleterious to OS and PFS, whereas cGVHD is strongly favorable, supporting an important role for the graft-versus-myeloma effect.
I think a five year survival for 38% of salvage transplant recipients is impressive. The key seems to be controlling the intensity of GVHD. Easier said than done! But apparently there’s hope.
Next, I wanted to pass along a link to a post I wrote on HelpWithCancer.org last week about the FDA decision to fast track a new pain medication for cancer patients that uses ingredients similar to those found in marijuana:
I was wondering why researchers couldn’t find a way to standardize dosing. This may be it.
Feel good and keep smiling! Pat