What I wish I knew about Multiple Myeloma treatments 25 years later...

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ASCT Now or Later? Makes No Difference in Multiple Myeloma

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Do you care more about how long you live (OS) or how long your multiple myeloma is in remission (PFS)?

While there is no guarantee of either longevity or a long remission, you are trying to choose between therapies based on averages. The articles linked an excerpted below speak to one of the most frequently asked questions I hear from newly diagnosed myeloma patients. “Should I have my autologous stem cell transplant now or should I wait?”

I believe that if newly-diagnosed multiple myeloma patients are not going to sacrifice overall survival by waiting  then they should wait. All MMers should harvest and store their stem cells once they complete their induction therapy. But the studies below report no difference in OS or PFS with an ASCT now or later.

Multiple Myeloma at a glance- click the image below:

Multiple Myeloma Mind Map

Many patients tell me that their oncologists are pushing for an ASCT now but they want to wait. The articles below answer an important question. There is NO difference based on your overall survival aka length of life.

And make no mistake. An autologous stem cell transplant is high-dose chemotherapy and is very toxic. When I had my ASCT at 36, the procedure  left me with a host of short, long-term and late stage side effects. Novel therapies such as Revlimid, Velcade, etc. have questioned the benefit of autologous stem cell transplantation for multiple myeloma patients.

Progression-Free Survival- The time for your multiple myeloma to progress from the date of your ASCT.

Overall Survival- The is how long MM patients live. Length of life. PFS measures time to when the cancer begins growing again after therapy.

In addition to the long and growing list of FDA-approved chemotherapy regimens that are cytotoxic to multiple myeloma, there is also a long and growing list of evidence-based, non-toxic therapies that are cytotoxic to multiple myeloma. I have lived in complete remission from my MM since ’99 by living an evidence-based, anti-MM lifestyle through nutrition, supplementation, bone health, etc.

I am both a long-term MM survivor and MM Cancer Coach. Click the link on the right of the page now to watch a free webinar about the Multiple Myeloma Cancer Coaching Program that I designed and created based on my 22 plus years living with MM.

Have you been diagnosed with multiple myeloma? What stage? Are you experiencing any symptoms such as bone pain, anemia or kidney damage?

Scroll down the page to post a question or comment. Thanks and hang in there.

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Early Or Late Stem Cell Transplantation For Myeloma? New Study Finds Both Strategies Yield Similar Overall Survival

“Results from a retrospective study show that delaying stem cell trans­plan­ta­tion following initial therapy may result in shorter progression-free survival following transplantation compared to transplantation soon after diagnosis.

However, the results also show that the timing of transplantation does not significantly impact overall survival…

Over the past 15 years, however, studies have shown that novel anti-myeloma agents – such as thalidomide(Thalomid), Revlimid (lenalidomide), and Velcade (bortezomib) – extend the progression-free and overall survival of myeloma patients.  Due to the efficacy and high tolerability of the novel agents, many myeloma patients in recent years have been choosing to delay or forego stem cell transplantation…”

Early versus delayed autologous stem cell transplant in patients receiving novel therapies for multiple myeloma

“Autologous stem cell transplant (ASCT) is an effective treatment for multiple myeloma (MM). However, the timing of ASCT in the era of novel agents (lenalidomide, thalidomide, bortezomib) is unknown.

We retrospectively reviewed the outcome of patients with MM who received novel agent-based induction treatment and received first ASCT within 12 months of diagnosis (early ASCT, n = 102) or at a later date (late ASCT, n = 65). Median time to ASCT was 7.9 months vs. 17.7 months in early vs. late ASCT. The 3- and 5-year overall survival (OS) from diagnosis was 90 and 63% vs. 82 and 63% in early and late ASCT, respectively (p = 0.45). Forty-one and 36 patients in the early and late ASCT groups have relapsed or progressed, with median time to relapse of 28 and 23 months (p = 0.055).

On multivariable analysis, factors predictive of increased risk for progression were International Scoring System (ISS) stage III (p = 0.007), and less than a very good partial response (< VGPR) post-ASCT (p < 0.001). A factor predictive of worst outcome for OS was being on hemodialysis (p = 0.037).

No superiority of one agent was seen. In summary, early or late ASCT is a viable option for patients with MM receiving induction treatment with novel targeted therapies.”

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