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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.

Multiple Myeloma Stem Cell Transplant- Safe for Elderly- But Beneficial?

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According to the IFM 2009 study, RVD induction plus stem cell transplant confers a longer PFS (first remission) compared to RVD alone. Yet there was no difference in Overall Survival at 4 years.

 

Let’s say that you are 69 years old. Let’s say you have just been diagnosed with multiple myeloma. You may consider 69 to be elderly, you may not. The study linked below considers 69, the average age of newly diagnosed MM patients, to be elderly.

Whether you consider yourself old or not, if you are diagnosed with MM, is your priority quality or quantity of life?

Multiple myeloma (MM) is a disease of the elderly. Stem cell transplant is standard-of-care for newly diagnosed MM patients. One the one hand, more elderly MM patients are being transplanted than ever before. On the other hand, research shows that there is no overall survival (OS) benefit.

I don’t believe that autologous stem cell transplantation benefits the elderly multiple myeloma patient.

Let me be specific.

  • Stem cell transplant is high-dose, aggressive chemotherapy causing a greater risk of short, long-term and late stage side effects-
  • Stem cell transplant research cites longer first remission (PFS) not length of life (OS)-
  • According to the study linked below, OS among the elderly is the same for stem cell transplant vs. novel therapies-

Let’s get back to my original question. Stem cell transplantation won’t, on average, help you life longer. Stem cell transplant, on average, means more toxicity, more side effects, lower quality of life.

Do you go for a stem cell transplant or not? Do you go for quality or quantity of life? Scroll down the page, post your reply, questions, comments, etc.

Now that I’ve questioned the need for an autologous stem cell transplant for you, consider RVD Lite rather than full dose RVD by reading the article linked below.

Choices, choices, choices…If you have any questions, scroll down the page, post your question and I will reply to you ASAP.

Hang in there,

David Emerson

  • MM Survivor
  • MM Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Transplant in Multiple Myeloma Deemed Safe in Older Patients — But Is It Necessary?

“Although myeloma is largely considered a disease of the elderly — the median age of diagnosis of 69 years2 — transplant is not always an option for, or offered to, patients 70 years or older…

Compared with 2013, when 15% of patients 70 years or older received transplant, by 2017, the number had almost doubled to 28%. Using patients aged 60 to 69 years as a reference, patients 70 years and older had a similar nonrelapse mortality  and overall survival…

Clifton C. Mo, MD,  also noted that this retrospective study adds value to the field by demonstrating that transplant can play a significant role on a case-by-case basis in patients of relatively advanced age. However, Dr Mo questioned whether many of these patients need to be transplanted given the significant advances in novel therapies made in the last 15 years…

In fact, in the current treatment era, sending patients to transplant in their first remission is increasingly becoming an area of controversy among myeloma specialists, he said.

“Historically, an ‘upfront’ transplant in first remission has been the standard of care, but, in my opinion, it is no longer a one-size-fits-all scenario where everyone fit enough to get a transplant should get one,” Dr Mo said. “There are now patients who may be able to do quite well in the long run without the need for immediate transplant.”

These advances are mainly due to the advent of multiple highly efficacious novel agents that are much better than their cytotoxic chemotherapy predecessors in terms of getting patients into deep and durable remissions

“In what I would call the ‘RVD [lenalidomide, bortezomib, and dexamethasone] era,’ the available evidence does not suggest an across-the-board survival benefit to upfront transplant in patients of any age,” Dr Mo said. “In the pre-RVD era, you could look a patient in the eye and confidently quote them a survival advantage by going to transplant in first remission, but I just don’t think the data allow us to do that anymore. It is a much grayer area now in terms of proven benefit.”

For example, the IFM 2009 Study showed that RVD therapy plus transplantation significantly prolonged progression-free survival compared with RVD alone, but overall survival at 4 years was not significantly different between the 2 groups.4…

For a fit patient aged 70 to 75 years, Dr Mo said he still presents ASCT as an option – especially for patients with high-risk cytogenetics and those with poor responses to initial novel agent therapy — but encourages patients to approach the decision to transplant cautiously, educating them about the real risks and significant toxicity…

Finally, Dr Munshi pointed to a racial disparity in the data indicating that Blacks are underrepresented among patients undergoing transplant. Of the almost 16,000 patients undergoing transplant included in the study, 78% had a self-reported race of White and 85% of patients 70 years or older self-reported as White.

However, Dr Mo said that it is important to note that overall outcomes for Black patients with myeloma in the United States are currently not inferior to those of Whites, suggesting novel therapies may in turn be further improving survival more broadly, given the observations described above.2″

VRd lite demonstrated high efficacy (for MM) with better tolerability in transplant-eligible patients with NDMM,” compared to full-dose RVd-

You’ve been diagnosed with multiple myeloma (MM). You are considering what MM chemotherapy you should undergo as your induction therapy. In addition, your oncologist is pushing an autologous stem cell transplant after your induction. Should you have an ASCT…now…later…?

Remember that MM is an incurable cancer. Living with multiple myeloma is a marathon, not a sprint. 

  • RVd is short for the multiple myeloma chemotherapy regimen called Revlimid (Lenalidomide), Velcade (Bortezomib) and Dexamethasone (dex).
  • RVd is usually considered the standard-of-care for induction therapy of newly diagnosed MM patients. 
  • The treatment duration for SOC induction therapy is usually 3-6 months or 3-6 monthly courses of RVD- it is important to keep in mind that, in my research and opinion, “less is more” if the MM patient achieves CR or MRD- status-
  • The issue between RVd lite and RVd heavy is the risk/reward or side effects caused by the toxicity of this triplet.

According to the article linked below, RVd lite is efficacious AND is better tolerated than full-dose RVd.

A key difference between High-Dose RVd and RVd Lite is that the usual amount of Revlimid (lenalidomide) has been reduced from 25 mg a day to 15 mg a day. By undergoing a lower dose of revlimid, there is a better chance of a positive result from low-dose revlimid maintenance therapy.

According to the study linked below, the ORR or the number of mm patients who respond to RVd lite is more than 80%. This is an excellent ORR.

Of that 80% plus who respond, almost 50% achieve very good partial remission (VGPR).

The issue then, is to understand your prognosis if you achieve VGPR, CR, or even MRD-. Will you live longer, on average, if you achieve one of the acronyms above? While MRD- status is correlated with longer life, is this correlation enough to offset the negatives that come from more toxicity, more chemotherapy?

I’ve never found a study that explains the question above. What I do know, is that less is more in multiple myeloma. At least when it comes to chemotherapy. Please consider:

  • pre-habilitation
  • integrative therapies 
  • complementary therapies

all shown to enhance the efficacy of your RVd lite.

I throw a lot of info at you above and I have probably introduced a lot of MM jargon to you. To learn more about pre-habilitation, integrative therapies and complementary therapies shown to manage multiple myeloma, scroll down the page, post a question or comment and I will reply to you ASAP.


Recommended Reading:


Common Starting Doses (for heavy dose RVd)-
  • Lenalidomide 25 mg by mouth daily for 14 days continuously, Days 1 – 14.
  • Bortezomib 1.3 mg/m2 subcutaneous injection on Days 1, 4, 8, and 11.
  • Dexamethasone 40 mg (ten 4 mg tablets) by mouth on Days 1, 8, and 15. OR.
  • Dexamethasone 20 mg (five 4 mg tablets) by mouth on Days 1, 2, 4, 5, 8, 9, 11, 12.

Modified Bortezomib, Lenalidomide, Dexamethasone Induction Regimen Efficacious, Tolerable for Transplant-Eligible Patients With Newly Diagnosed Multiple Myeloma

“A recent study demonstrated the efficacy and tolerability of a modified induction protocol for patients with newly diagnosed multiple myeloma (NDMM) who are eligible for autologous stem cell transplantation (ASCT)…

According to the study authors, induction with therapy combining bortezomib, lenalidomide, and dexamethasone (full dose VRd) shows high efficacy but with limited tolerability in some patients.

In the VRD lite regimen used in this study:

  • subcutaneous bortezomib (velcade) dosed at 1.3 mg/m2
  • dexamethasone (40 mg) was administered on the days that bortezomib was given.
  • Oral lenalidomide (revlimid) was given at a dosage of 15 mg on days when bortezomib was not given

The authors reported an overall response rate (ORR) of 83%,

with a very good partial response (VGPR) or better rate of 48%.

Patients who completed 4 or more cycles of VRd lite had an ORR of 87% and a VGPR or better rate of 50%.

Of 38 patients who received 4 or more cycles of VRd lite and underwent ASCT, the ORR was reportedly 100%, with a VGPR or better rate of 74%.

  • Lymphocytopenia was reported in 46% of patients,
  • neutropenia in 31%
  • liver dysfunction and peripheral neuropathy each occurred in 27%.
  • Grade 3 neutropenia occurred in 19% of patients, and
  • grade 4 neutropenia occurred in 6%.

Dose modifications were reported in 15.2% of patients in this study.

“In this retrospective analysis, VRd lite demonstrated high efficacy with better tolerability in transplant-eligible patients with NDMM,” the study authors wrote in their report.”

The efficacy and safety of modified bortezomib-lenalidomide-dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma.

  • “The overall response rate (ORR) after four cycles of VRd lite was 83%,
  • complete response of 25%.

Thirty-eight among the 45 patients who completed at least four cycles of VRd lite received autologous stem cell transplantation (ASCT). The ORR and very good partial response or better were upgraded to 100% and 74%, respectively, following ASCT.

 

 

 

 

 

 

 

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