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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Multiple Myeloma- Early, Late Autologous Stem Cell Transplant… or Ever?

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“…have raised the question whether autologous transplant is nowadays still needed to treat Multiple Myeloma patients or if it should be replaced by new drug containing regimens with or without chemotherapy”

When a person is diagnosed with multiple myeloma, an incurable blood cancer, the most pressing issue that he or she will face is whether to undergo autologous stem cell transplantation. Close behind this question will be whether to have the ASCT immediately following induction therapy or to wait before undergoing an ASCT. A distant question will be if the newly diagnosed MMer should have an ASCT ever.

Unfortunately, the study below does not answer the early/late question fully. Clinical trials have danced around the issues playing fast and loose with some of the key factors needed for MMers to decide. The bottom line for newly diagnosed MMers is that research will not answer the ASCT now or later question. The patient and his/her support team must decide based on their understanding, priorities, and goals.

What the study below does address is several important issues that newly diagnosed MMers should understand. And those issues are:

  • New drugs aka novel therapies have significantly increased the rate of high-quality responses and improved outcomes,
  • the manageable toxicity of these new drugs aka novel therapies make them suitable for long-term and continuous treatment
  • harvest and store your stem cells no matter how you feel about ASCT now-

Conventional oncology agrees that ASCT is high-dose, aggressive therapy. Make no mistake, ASCT can mean serious short, long-term and late-stage collateral damage. The question is when to undergo this aggressive, high-dose therapy and if you will live a better, longer life with or without it.

I am both a long-term MM survivor and MM cancer coach. Please scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

First line vs delayed transplantation in myeloma: Certainties and controversies

“Since the middle of 1990s autologous stem cell transplantation has been the cornerstone for the treatment of young patients with multiple myeloma (MM). In the last decade the introduction of novel agents such as immunomodulatory drugs (IMiDs) and proteasome inhibitors (PI), has dramatically changed the therapeutic scenario of this yet incurable disease. Due to the impressive results achieved with IMiDs and PI both in terms of response rates and in terms of progression-free and overall survival, and to the toxicity linked to high dose therapy and autologous stem cell transplantation (ASCT), a burning question nowadays is whether all young patients should be offered autotransplantation up front or if this should be reserved for the time of relapse. This article provides a review of the data available regarding ASCT in MM and of the current opinion of the scientific community regarding its optimal timing…

The introduction of these drugs (the immunomodulatory drugs (IMiDs)), as part of the frontline treatment in both transplant eligible and non-eligible patients translated into a markedly increased rate of complete remission (CR), time to progression (TTP), progression-free survival (PFS) and overall survival (OS)[,,].

In patients ineligible to ASCT, the addition of bortezomib to the conventional melphalan and prednisone (MP) treatment translated into a rate of CR of 30%, with an OS at 5 years of 56.4 mo[,]. These impressive results, comparable to the rate of CR and OS achieved with ASCT, have raised the question whether autologous transplant is nowadays still needed to treat MM patients or if it should be replaced by new drug containing regimens with or without chemotherapy. In this latter case, ASCT would be used as a salvage treatment at the time of progression in patients initially treated with novel agents. This review will focus on the current role of ASCT for the treatment of MM patients…

The introduction of novel agents in the induction phase before and in a consolidation or maintenance phase after ASCT has further improved the outcomes of MM patients, increasing response rates, PFS and OS (Table (Table2).2). The combination of thalidomide and dexamethasone (TD) or of thalidomide with conventional chemotherapy has significantly increased the rate of responses compared to chemotherapy alone…

The high rate of good quality responses seen with the incorporation of PI and IMiDs as induction before, and consolidation and maintenance after ASCT translated into an increase of both PFS and OS; in consideration of these results, and of the toxicity associated with HDT and ASCT, a burning question nowadays is whether new treatments alone, without the use of upfront ASCT, would be sufficient to treat young MM patients[]. In this scenario, it is worth noting that the majority of patients enrolled in clinical trials that were not treated with ASCT upfront could still receive it at the time of relapse…

In the era of novel agents, two studies have retrospectively analyzed the role of early vs delayed ASCT[,] and one study prospectively evaluated a second ASCT after relapse from a previous one[]. One study reported the outcomes of 290 patients treated with IMiDs based therapy (thalidomide or lenalidomide) and that received early (within 12 mo of diagnosis) or late ASCT; PFS was similar irrespective of when ASCT was performed (early or late) and no significant difference could be observed in OS, with both groups experiencing a 4-year OS of 73%[]. In a similar study Dunavin et al[] retrospectively reviewed the outcome of 167 patients treated with novel agent-based therapy (IMiDs or PI) and receiving early or delayed ASCT. The 5-year OS from diagnosis was similar in the two groups (63% both in early and late ASCT, P = 0.45), in accordance with the data reported by Kumar et al[]…

As already stated the advent of new drugs has dramatically changed the therapeutic scenario of MM patients. Not only an induction treatment comprehensive of new drugs significantly increased the rate of high-quality responses and improved survival outcomes[,,,], but the manageable toxicity of these compounds make them suitable for a long-term and continuous treatment[,]…

CONCLUSION- In the era of novel agents the appropriate timing for performing ASCT, whether upfront or at relapse, is still a burning question. If on one hand, it is true that early ASCT improves PFS rates, on the other hand, it is associated with a higher toxicity compared to a treatment with novel agents[]. It has to be also acknowledged that, whilst almost all randomized studies showed longer PFS for early ASCT, the benefit on OS was not uniformly reported[,]. The lack of advantage observed in some cases in terms of OS is mainly due to the effective salvage therapy nowadays available, and to the possibility for patients to receive ASCT later in their disease history as a salvage treatment.

For this reason, some centers nowadays recommend ASCT only for those patients with high-risk features, whilst for standard risk patients, a treatment option reserving ASCT for the time of relapse is considered acceptable[]. In this contest it has to be emphasized, in patients for whom a delayed ASCT may be considered, the extreme importance of early stem cell collection and cryopreservation; an early stem cell collection is particularly important in those patients receiving lenalidomide based treatments[,]…”





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1 comment
MARTINE BRUNET says 4 years ago

My husband has been in remission after a Rev/dex/Ninlaro regimen over a year ago. He was diagnosed in 2003 and at that time there were not many treatments available and the MM specialists were pushing transplants a lot. At the time David was one of the few people who opened our eyes to alternatives. Now when we go to Dana Farber, the doctors are a lot less enthusiastic about transplants due to, as David said, the many more options available in treatments. We also changed our lifestyle to eat healthier and supplement to lessen the side effects. In conclusion, if you can, seek a second opinion with an MM specialist who will review your case and help you decide.

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