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Myeloma Diagnosis- ASCT vs. Novel Therapies?
“However, therapies such as new immunomodulatory drugs and proteasome inhibitors and, more recently, monoclonal antibodies and chimeric antigen receptor T cells are challenging the traditional role of ASCT.”
Hi David- I just discovered your site, and am brought up kind of short. My wife (six years into MM diagnosis, has just had ASCT, seems to be doing extremely well, we think because of her integrative (acupuncture, homeopathy, IVC, etc) approach.
But this—“Countless studies document novel therapies providing as long an overall survival as ASCT with less toxicity and therefore reduced risk of short, long-term and late stage side effects.”
—Could you point me to this research and these therapies? Thank you. MM Caregiver
Hi MM Caregiver-
Several issues. First, I am sorry to learn of your wife’s MM diagnosis. If I read your email correctly, your wife underwent both complementary as well as integrative therapies before she had an ASCT? Without knowing her specifics, I’m guessing that this “pre-habilitation” helped her do “extremely well.”
I am not minimizing the benefit of conventional MM therapies. I am just saying that experience and research has shown me that a combination of convention and non-conventional therapies provides the best combination of killing MM as well as not killing/damaging the MM patient.
Secondly, regarding your question, I have linked and excerpted a study below that points to the issue you are asking about. Though the study doesn’t come out and say it specifically-
- ASCT has been the standard-of-care for newly diagnosed MM patients without ever conclusively proving a longer “overall survival.” OS is length of life. Progression-free survival (PFS) is the term for the MM survivors length of first remission.
- To your question, the study then highlights concepts like fewer side effects, higher response rates, and overall response rates. The study questions the fact that ASCT may not be the best therapy option for all newly diagnosed MM patients without saying it specifically.
I’ve read enough studies like the one below, that question different aspects of ASCT. The primary issue being OS when compared to short, long-term and late stage side effects.
I believe that the issue is a risk-reward equation. The risk of side effects of an ASCT is not worth the reward if OS (length of life) is the measure of reward.
All that being said, the MM patient improves the risk/reward equation if he/she undergoes non-toxic, non-conventional therapies such as the ones you mention. Keep in mind that conventional only and the FDA do not consider these therapies to be in the equation for MM patients.
- I would also plug frequent, moderate exercise
- Anti-MM nutrition
- Anti-MM nutritional supplementation such as curcumin, resveratrol, etc.
I hope I’ve answered your question. Let me know if you have any other questions.
Thanks for reading my post so carefully. I appreciate it.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
Are Autologous Stem Cell Transplants Still Required to Treat Myeloma in the Era of Novel Therapies?
“Melphalan at a myeloablative dose followed by autologous stem cell transplantation (ASCT) remains the standard of care for transplant-eligible patients with myeloma. However, therapies such as new immunomodulatory drugs and proteasome inhibitors and, more recently, monoclonal antibodies and chimeric antigen receptor T cells are challenging the traditional role of ASCT. Which patients benefit from ASCT? Can its use be delayed until first relapse? The field is moving rapidly as novel agents lead to new patient care strategies. The place of ASCT in this changing landscape will be reviewed and reassessed…
Although only some of the original randomized clinical trials of ASCT in myeloma reported an overall survival (OS) benefit, there was a consistent improvement in progression-free survival (PFS), and the use of a single ASCT became the standard of care for younger patients, generally younger than 65 years, who could tolerate the procedure safely, so-called transplant-eligible patients 9, 10, 11, 12, 13….
However, results for OS were inconsistent, and over time, the use of tandem ASCT declined.
In parallel, numerous new therapeutic options have been discovered, starting with the immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) (Figure 1). Thalidomide, the original IMiD [14], was replaced by lenalidomide and pomalidomide, more potent agents that are less likely to cause neuropathy. The current focus is on agents such as iberdomide, which appears to have some efficacy in patients who are refractory to all other IMiDs.
Proteasome inhibitors have also improved both the response rates and the corresponding depths of response..”
Cancer prehabilitation: One step toward improved outcomes
“Oncology nurses are critical to the delivery of high-quality cancer care and, as such, they are frequently introduced to patients immediately following a diagnosis. Indeed, nurses often spend more time with survivors with newly diagnosed cancer than any other health care professional. This early access provides a perfect opportunity for them to not only provide education and moral support, but also administer assessments to determine how cancer prehabilitation could be used to improve patients’ health outcomes.
The future of high-quality cancer treatment will increasingly focus on patient-centered care, supported by a strong evidence base and highly skilled providers. Nurses, particularly navigators, are uniquely positioned to deliver efficacious prehabilitation services.
With this unique opportunity comes the responsibility to understand the evidence-based research and incorporate it into a best practices clinical approach to improving cancer care. Because research in this area of medicine is rapidly evolving, nurses should consider pursuing formal training and continuing education in cancer prehabilitation and collaborate more closely with rehabilitation health care professionals…”