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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.

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″








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