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Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

Click the orange button to the right to learn more about what you can start doing today.

Autologous Stem Cell Transplant- NO OVERALL SURVIVAL for Myeloma

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These results were confirmed by a meta-analysis that showed a significant benefit for HDT/ASCT in terms of EFS but no benefit in terms of OS (in myeloma)...”

The standard-of-care (SOC) for newly diagnosed multiple myeloma (MM) patients who are eligible is induction chemotherapy of a triplet called RVd, or VRd (revlimid, velcade, dexamethasone) followed by an Autologous Stem Cell transplant (Hematopoietic stem cell transplant).

In MM most newly diagnosed MM patients are encouraged by their oncologists to have an autologous stem cell transplant (ASCT). Autologous meaning the stem cells come from you. You’d think that the SOC would mean longer average overall survival (OS- length of life) for the MM patient, wouldn’t you?

That’s what I thought when my oncologist told me that I should have an ASCT in early 1995 when my pre-MM became full-blown MM.

The Pubmed article linked and excerpted below is important for two reasons. First, the article lists ten of the most important questions to ask your oncologist before you have an ASCT.

Secondly and most importantly is the fact that ASCT procedures do not increase overall survival (OS) or average length of life. ASCT can increase your event-free survival (EFS) or how long your first remission lasts before relapse.

A newly diagnosed myeloma patient considering an autologous stem cell transplant must consider the advantages of a longer PFS (progression-free survival aka remission) with the increased risk of

  • short,
  • long-term and
  • late stage

side effects that can accompany high-dose chemotherapy aka an autologous stem cell transplant.

  • EFS- event-free survival- time before anything bad happens…
  • PFS- progression-free survival- time before your MM relapses…
  • OS-overall survival- how long you live…

I am both a MM survivor and MM Cancer Coach. If you are considering a stem cell transplant, novel chemotherapies and/or evidence-based therapies proven to be cytotoxic to MM scroll down the page to ask a question or make a comment. Tell me your MM stage and symptoms and tell me what’s on your mind. I will reply ASAP.

thanks,

David Emerson

  • Long-term MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Treatment of autologous stem cell transplant-eligible multiple myeloma patients: ten questions and answers

“Autologous stem cell transplantation is currently considered the standard of care (SOC) for multiple myeloma in young patients with adequate organ function, based on the results of trials conducted in the era prior to the advent of novel agents.

While these trials demonstrated the superiority of high-dose therapy with stem cell support over conventional chemotherapy, relapse remained an issue for the majority of patients.

With the introduction of the novel agents, a dramatic change in treatment strategies in the transplant setting has taken place. These agents are now incorporated prior to and following the transplant procedure, and have resulted in improvements in outcome.

Importantly, improvements have also been seen in patients with high-risk cytogenetics and renal impairment. In the era of novel agents, the role of transplant itself is being questioned and trials are ongoing to establish whether transplant can be delayed until after relapse in some patients.

The current ongoing studies are aimed towards improving the different steps of the procedure with the aim of further improving efficacy and tolerability. This review addresses a number of questions surrounding the different steps of the transplant procedure and summarizes the available research evidence as a basis for decision making…”

Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma.

“Autologous stem cell transplant (ASCT) is standard consolidation therapy in management of multiple myeloma (MM) patients…

Median time from diagnosis to transplant was 7 months (3-79), with majority of patients underwent transplant in first remission, while 17 (12%) patients received transplant beyond first remission.

Eighty-three percent patients obtained CR/VGPR post-ASCT. Transplant-related mortality was 2.1%.

At a median follow up of 54 months, mean overall survival (OS) and progression-free survival (PFS) group were 128.3 months (95% C.I. 111.9-144.7 months) and 73.8 months (95% C.I. 57.7-89.9 months), respectively.

On univariate analysis, OS was adversely affected by renal insufficiency (p = 0.024), while OS was better with CR/VGPR post-ASCT (p < 0.001) and lenalidomide maintenance therapy (p = 0.009). PFS was affected by CR/VGPR pre-ASCT (p = 0.021), CR/VGPR post-ASCT (p < 0.001), and transplant in first remission (p = 0.034). On multivariate analysis, lenalidomide maintenance (versus thalidomide) (p = 0.007) and CR/VGPR response post-ASCT (p = 0.0003) were found to be predictors for better OS and CR/VGPR response at transplant for better PFS (p = 0.038). Transplant in first remission versus beyond first remission showed a trend for better PFS (p = 0.073).

CONCLUSION: Majority of patients obtained CR/VGPR post-ASCT. Longer PFS was seen with patients who were transplanted in first remission.”

 

Leave a Comment:

40 comments
Einav Strammer says 6 months ago

Hello David,
First of all thank you for your important mission in life which I’m sure helps so many MM survivors.

I’m 43 years old (tomorrow…:-)) and I was diagnosed in Dec 2020 with a smoldering Myeloma (Igg lambda which now with the treatments in range, fortunately with no lesions on my bones as the Pet-CT showed, so it is restricted to the marrow bone, but a high risk one with translocation of t14;16 and d13.

Therefore, the recommendation was to start VRD + Daratumumab (which I’m undergoing now) and later on ASCT. I understood that even though in the coming future CAR-T might replace the ASCT, in high risk patients in order to get deep remission it is highly recommended to have ASCT.
Moreover, the way I see it, “the game” here is to buy time, as longer as I can in remission, so that hopefully when it will relapse there will be new and better treatments more “Hi-Teck” ones immunology and no chemo at all. I would really like to hear what you think and what would you do. Thanks in advance!

Reply
    David Emerson says 6 months ago

    Hi Einav- I am going to reply to your email directly. Thanks.

    David Emerson

    Reply
Brad schott says 11 months ago

I was diagnosed with MM and I have four cycles of the drugs you mentioned just halfway through the second cycle. Wondering if I need to do the stem cell transplant. I am 54 only thing weird was my IGa protein numbers which are now in the normal range. Had a few broken ribs over the summer and some pretty painful back spasms but most are getting better now. Doing the Velcade Revlimid treatment I like reading your story so positive.

Reply
    David Emerson says 10 months ago

    Hi Brad-

    I replied to you via your email address.

    David Emerson

    Reply
dale peever says 11 months ago

hi David was diagnosed in november 2019. had a stem cell transplant autologous.. in may 2020.. doing real well and bloodwork has been great.. im starting a rivlimid treatment soon aswell.

Reply
    David Emerson says 11 months ago

    Sounds good Dale- Let me know if PBC can do anything for you.

    David Emerson

    Reply
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Cindy says last year

Hi David
I am at the stage where they want to to the Stem Cell Transplant. I went and got a second opinion and the doctors don’t agree at all – now I am feeling more confused than ever. I was diagnosed in January with Stage III MM – 90% in the marrow and a p17 deletion. I just finished four cycles of RVD and my numbers have almost gone back to normal. I have changed my diet to plant based and to me it seems like this has catapulted my health back to normal. I have no symptoms other than my knee started to hurt (I do have a torn meniscus) it was at this appointment that they noticed my protein was high … the rest was confirmed from there.

Reply
    David Emerson says last year

    Hi Cindy-

    I will reply to your post via an email to you directly.

    David Emerson

    Reply
Eva Berriman says last year

So the question becomes for me the individual assessment of the trade off between:
1) ASCT with possible longer progression-free survival – which hopefully means less damage to the body from the disease progression vs
2) no ASCT with the risk of earlier disease progression, but less damage to the body from the toxic treatment.

Did I understand that somewhat correctly?

Reply
    David Emerson says last year

    Hi Eva- Great question. Long reply. I am going to reply to this and email you directly with my reply. Thanks.

    David Emerson

    Reply
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Kathryn Guillaum says a couple of years ago

Redundant but here goes. I was diagnosed a few days ago with MM.I have no noticeable symptoms yet. No bone pain (usual back pain from 2011 accident). I am not losing weight either. I just turned 70 in Aug.
Oct. 10th, I have a consult. and X-ray and was supposed to start first I.V and pills. However I need to get a tooth pulled,so no treatment till that is done. So I have time to research. Please forgive me, but I worry that you are selling false hope. I don’t have time or money for that. I have to find something, so I’m betting my life…so to speak. Looking forward to your webinar, tomorrow evening. More power to…..your health, young man!

Reply
    David Emerson says a couple of years ago

    Hi Kathryn-

    I will email you again based on this info- D

    Reply
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Carol Keise says 3 years ago

It seems to me that stem cell transplants does extent life. But is very risky. We rarely here about the instances where transplants failed.

Reply
    David Emerson says 3 years ago

    Hi Carol,

    The issue is what is meant by “extend life.” Yes, an ASCT does extend life compared to the newly diagnosed MM doing no therapy at all. However, numerous studies show that newly diagnosed MMers do NOT live longer comparing ASCT to novel therapies whether they are doublets or triplets. What has been shown by research, it that ASCT does result in longer “progression-free survival” aka PFS. Meaning the MMer will, on average, enjoy a longer remission. But length of life (OS) is the same compared to chemotherapy.

    That might be more info that you wanted but I think MMers need to understand their options.

    thanks,

    David Emerson

    Reply
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