Autologous Stem Cell Transplantation for Multiple Myeloma- Overall Survival vs. PFS

“Hematopoietic stem cell transplantation (ASCT) remains a dangerous procedure with many possible complications; it is reserved for patients with life-threatening diseases”

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You have been diagnosed with multiple myeloma (MM). Your oncologist has included an Autolgous Stem Cell Transplant (ASCT) in your therapy plan. I was diagnosed with MM in early ’94 and underwent an ASCT in 12/95.

Please understand that a Hematopoietic stem cell transplantation (HSCT) is aggressive therapy for multiple myeloma patients and can bring serious short, long-term and late stage collateral damage aka side effects.

More importantly, please understand that this aggressive procedure does not result in increased overall survival. Dispite years of research and dozens of studies, no research has ever determined that the patient achieves, on average, longer overall survival. Perhaps longer progression-free survival (longer first remission) but not longer OS or length of life.

The decisions you make about your ASCT, auto, allo, umbilical cord, etc. transplant will increase or decrease your risk of success in terms of engraftment, side effects, and overall survival.

I am both a multiple survivor and MM cancer coach. I underwent an autologous stem cell transplant in December of ’95. The procedure left me with serious chronic side effects. While this therapy can be lifesaving I encourage you to consider those evidence-based, non-conventional therapies that can reduce your risk of collateral damage while increasing your risk of a positive outcome.

To learn more about evidence-based therapies to reduce your risk of side effects, scroll down the page, post a question or comment and I will reply ASAP.

thank you

David Emerson

Cancer Survivor
Cancer Coach
Director PeopleBeatingCancer

Recommended Reading:

Hematopoietic stem cell transplantation

“Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood. It may be autologous (the patient’s own stem cells are used) or allogeneic (the stem cells come from a donor)… In these cases, the recipient’s immune system is usually destroyed with radiation or chemotherapy before the transplantation. Infection and graft-versus-host disease are major complications of allogeneicHSCT.

Hematopoietic stem cell transplantation remains a dangerous procedure with many possible complications; it is reserved for patients with life-threatening diseases. As the survival of the procedure increases, its use has expanded beyond cancer, such as autoimmune diseases.^[1]^[2]“

The studies linked below compare key issues such as donor bone marrow blood stem cells vs. donor peripheral blood stem cells in a bone marrow transplant, engraftment, complications (both physical and mental) and overall survival rates.

Long-Term Survival and Late Deaths After Allogeneic Hematopoietic Cell Transplantation

“Purpose Allogeneic hematopoietic cell transplantation (HCT) is curative but is associated with life-threatening complications. Most deaths occur within the first 2 years after transplantation. In this report, we examine long-term survival in 2-year survivors in the largest cohort ever studied…

Conclusion The prospect for long-term survival is excellent for 2-year survivors of allogeneic HCT. However, life expectancy remains lower than expected. Performance of HCT earlier in the course of disease, control of GVHD, enhancement of immune reconstitution, less toxic regimens, and prevention and early treatment of late complications are needed.”

Therapy Improves Stem Cell Engraftment in Umbilical Cord Blood Transplant Recipients, Study Suggests

“A therapy involving a natural compound may improve the ability of stem cells from umbilical cord blood to engraft in patients receiving a stem cell transplant for cancer or other diseases…FT1050-treated blood-forming stem cells are being tested as a possible solution to one of the major shortcomings of transplants involving stem cells from umbilical cord blood: the relatively small number of stem cells infused in such procedures often take longer to engraft.”

Bone Marrow and Blood Stem Cell Transplant Survival Rates Equal, When Donor Is Unrelated to Patient

“Patients who receive a blood stem cell transplant from a donor outside of their family to treat leukemia and other blood diseases are more likely to have graft failure but less likely to experience graft-versus-host disease, a condition caused by the donor cells attacking the recipient’s body, if the transplanted blood cells come directly from a donor’s bone marrow, rather than from blood stem cells circulating in the donor’s bloodstream (PBSCs), according to new research.

Although the study showed differences in the type and extent of complications, the results showed no difference in patient survival rates between these two major sources of donated blood cells.

PBSCs resulted in better engraftment than bone marrow, but was associated with higher rates of chronic graft-versus-host-disease (GVHD) (53% compared with 40% in bone marrow), and the GVHD was also more extensive. GVHD is a serious and often deadly post-transplant complication that occurs when the newly transplanted donor cells recognize the recipient’s own cells as foreign and attack them.”

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Helen Wiszniowski says 4 years ago

My son , 41, is to start chemo for myeloma next week. If tests show that the cancer is gone, he wants to stop the next step… stem cell transplant. Does data show that remission is the same or different if one does not do stem cell?. Also, because we live in Ontario, the chemo cocktail is CyBorD. Is this any better or worse than the 3 that are used in the States.
I saw your name on the patient list for Dr Burzynski. We can’t afford it, but what did your treatment cost per month and how long were you treated?
Do you believe in the immunotherapy approach done by the Mayo clinic and what are your thoughts on the new French discovery, presented at the European symposium, regarding myeloma treatment?
I know this is a lot, but he is so young and I am so scared.
Thank you.
Helen

David Emerson says 4 years ago

Hi Helen,

Thank you for becoming a member of the MM Cancer Coaching program. I will reply to your questions via email.

Alexandra says 4 years ago

Thank you for your article it couldn’t have come at a better time for me. I’m in to my fifth cycle of velcade, dexamathasone and thalidomide, they are planning to start priming me for stem cell transplant in September. I’m doing as much research as I can to help me make the decision on whether to have stem cell or not as I feel that now the paraprotein level has come down I have time to explore less aggressive treatment options.

Hi Alexandra,

I am sorry to learn of your MM diagnosis though good to see you are weighing all your options. I will make a couple of points and then ask you a few questions.

1) ASCT is considered the “standard-of-care” for MM. All MM patients are encouraged to undergo this therapy regardless. Your job is to think about what is best for you, what therapies accomplish your goals. Cure vs. control in mm

2) Progression-free survival vs. overall survival- first remission vs. length of life- important distinction.

3) Questions- what stage where you at diagnosis? Or what symptoms where you experiencing? Bone damage? Kidney damage?

4) Have you had blood work recently? You mention the paraprotein level “coming down.” Where was your m-spike at diagnosis and where is it now?

5) Are you experiencing any side effects from VAD thus far? Peripheral neuropathy? Chemobrain?

It will be easier for us to communicate via email. My email address is daviddecemerson@me.com.

Let me know, thanks.

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Autologous Stem Cell Transplantation for Multiple Myeloma- Overall Survival vs. PFS

“Hematopoietic stem cell transplantation (ASCT) remains a dangerous procedure with many possible complications; it is reserved for patients with life-threatening diseases”

Recommended Reading:

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