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.
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Early Relapse Autologous Stem Cell Transplant?
What does an early relapse post-autologous stem cell transplant mean for the newly diagnosed MM patient? What can be done about it?
According to the research linked below, early relapse of NDMM patients receiving ASCT within 12 months of diagnosis is a relapse occurring within 24 months of their ASCT.
Study results vary, but between 37% and 44% of NDMM patients relapsed in 24 months or less after their ASCT.
Relapsed After Stem Cell Transplant—Should You Do Another or Try New Therapy? | Myeloma Insights
What can be done for MM patients who experience an early ASCT relapse?
Conventional therapies-
For patients relapsing within 24 months (especially under 12 months) post-ASCT:
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Second ASCT is usually not the best option unless prior remission was durable.
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Combination regimens using newer PIs, IMiDs, and mAbs are a mainstay.
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Aggressive salvage chemo can serve as a temporizing step en route to clinical trials.
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Emerging agents—especially CD38 mAbs like isatuximab and ADCs like Blenrep—are promising and increasingly accessible.
Non-conventional therapies-
Microbiome-supportive habits
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Why: The gut microbiome is disrupted by ASCT and antibiotics; lower diversity has been associated with worse post-transplant outcomes in hematologic cancers and MM cohorts. Diet quality (fiber, plants) tracks with more favorable profiles. PMCASTCT JournalFrontiers
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How: Emphasize plant-forward meals (beans, whole grains, fruits, vegetables, nuts), fermented foods if neutrophils are adequate and your center allows them; minimize unnecessary antibiotics. (Avoid OTC probiotics during neutropenia unless your team explicitly okays them.)
I am a long-term MM Survivor. Email me at David.PeopleBeatingCancer@gmail.com to learn more about both conventional and non-conventional MM therapies.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- Stem Cell Transplant- Treatment-related Secondary Cancer
- How Painful is Multiple Myeloma?
- Multiple Myeloma- Early, Late Autologous Stem Cell Transplant… or Ever?
Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time
Abstract
Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM) particularly for upfront autologous hematopoietic cell transplant (AHCT) recipients. We hypothesized that new drug classes and combinations employed prior to AHCT as well as after post-AHCT relapse may have changed the natural history of MM in this population.
We analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of MM patients receiving single AHCT within 12 months after diagnosis (N=3256) and relapsing early post-AHCT (<24 months), and to identify factors predicting for early vs late relapses (24−48 months post-AHCT).
Over three periods (2001–2004, 2005–2008, 2009–2013), patient characteristics were balanced except for
- lower proportion of Stage III,
- higher likelihood of one induction therapy with novel triplets
- and higher rates of planned post-AHCT maintenance over time.
The proportion of patients relapsing early was stable over time at 35–38%.
Factors reducing risk of early relapse included
- lower stage,
- chemosensitivity,
- transplant after 2008
- and post-AHCT maintenance.
Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, stage III, >1 line of induction and lack of maintenance. Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time.
Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk
…The Toulouse Ethics Committee approved the study and written informed consent was obtained for all patients included. Clinical data were obtained from 2,627 patients followed >18 months or having relapsed, and for whom diagnosis of MM was established between April 1, 2004 and August 17, 2018.
Patients who had primary refractory disease were not included. All patients received an intensive approach with either a doublet-based induction (38%) including PI or a triplet-based (62%) including a PI and an IMiD, followed by ASCT and consolidation by same regimen as induction.
Twelve percent of the cohort also received an IMiD-based maintenance. Depth of response and progression were determined based on criteria defined by the International Myeloma Working Group.6
Relapse was considered early if it occurred within 18 months of starting initial therapy, which is equivalent to relapse within 12 months from ASCT.1,2
Survival analyses were performed using Landmark analysis at 18 months after initiation of treatment to reduce the guarantee time bias, reducing the cohort to 2,474 patients (n=153 excluded because followed <18 months, see the Online Supplementary Figure S1).
The data was summarized by frequency and percentage for categorical variables and by median and range for continuous variables…
In conclusion, despite efficient post-relapse treatment, ER is strongly associated with reduced survival in both high- and standard-risk cytogenetic groups, and should be included in high-risk MM definition.
Our data confirms that the prognosis established at diagnosis is a dynamic data which can evolve according to response to treatment, raising the question about the merit of current risk-adapted therapy and underlying the need to explore mechanisms of relapse.
In addition, this study suggests that despite important progress in salvage therapy, the first line of treatment must be the most efficient as possible.
early relapse autologous stem cell transplant early relapse autologous stem cell transplant