“However, patients were just as likely to be alive more than 6 years after treatment regardless of whether or not they underwent an immediate autologous stem cell transplant.”
The FDA standard-of-care therapy plan for all newly diagnosed multiple myeloma (MM) patients is induction therapy followed by an autologous stem cell transplant (ASCT).
The first question asked by many/most NDMM patients is about the difference between an autologous stem cell transplant now or later? The answer, according to numerous studies including the one linked and excerpted below, comes down to:
- Progression-free Survival (PFS)
- Overall Survival (OS)
- Side Effects
On average, if you undergo an ASCT immediately following your induction chemotherapy, you will have a longer progression-free survival. On average, if you do not undergo an ASCT immediately following your induction therapy you will have a shorter PFS.
However, again, according to the study linked below, you will have
- the same overall survival aka length of life and
- fewer side effects including a lower risk of secondary cancers
An ASCT is aggressive, high-dose chemotherapy. That much toxicity causes a host of short, long-term and late stage side effects. These health problems are well-documented.
I realize I am only one MM example but I developed chemobrain, cardiomyopathy, avascular necrosis and many other side effects as a result of my own ASCT.
If you choose to harvest your stem cells following your induction therapy, consider these steps:
- harvest your stem cells- freezing stem cells is standard these days-
- keep an eye on your diagnostic testing results- if you achieve a complete remission or even a VGPR, following your induction therapy, research shows little benefit (and a lot of possible harm) if you undergo more toxicity right then…
- in other words, take your therapies one step at a time. ASCT is serious therapy. You may benefit, you may not…
Lastly and most importantly, according to MM specialist Dr. Paul Richardson,
“Now more than ever, treatment for multiple myeloma can be adapted for each patient,” Richardson commented. “Our study provides important information about the benefits of transplant in the era of highly effective novel therapies…Patients who did not undergo immediate transplant received treatment when their disease progressed with newer and active therapies, such as monoclonal antibodies and/or next-generation novel agents, he noted. Only 28% of patients used the reserve option of a transplant.”
I think what Dr. Richardson is saying in the quotation above is what Dr. Rajkumar is saying in his post “Treatment of Myeloma: Cure vs. Control” linked below. And that is to take the treatment of your incurable blood cancer one step at a time.
Have you been diagnosed with Multiple Myeloma? Are you wondering about an ASCT now or later?
Scroll down the page, post a question or a comment. I will reply to you ASAP.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
“The length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. In a clinical trial, measuring the progression-free survival is one way to see how well a new treatment works. Also called PFS.”
The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the overall survival is one way to see how well a new treatment works. Also called OS.
“Although not often openly acknowledged, “cure vs control” is the dominant philosophical difference behind many of the strategies, trials, and debates related to the management of myeloma. Should we treat patients with myeloma with multidrug, multitransplant combinations with the goal of potentially curing a subset of patients, recognizing that the risk of adverse events and effect on quality of life will be substantial? Or should we address myeloma as a chronic incurable condition with the goal of disease control, using the least toxic regimens, emphasizing a balance between efficacy and quality of life, and reserving more aggressive therapy for later?…”
“New results from a trial in patients with newly diagnosed multiple myeloma offer some answers to questions about which treatment route to choose.
The trial, known as DETERMINATION, found that newly diagnosed patients treated with a triplet of drugs had longer progression-free survival (PFS) if they received an autologous stem cell transplant (ASCT) soon after the drug therapy than if they simply had their stem cells collected for a possible future transplant.
Patients who received the triplet of lenalidomide, bortezomib, and dexamethasone (RVD) plus ASCT had a median PFS of 67.5 months, compared with 46.2 months for those who received RVD but did not have a transplant soon after.
- However, patients were just as likely to be alive more than 6 years after treatment regardless of whether or not they underwent an immediate stem cell transplant.
- In addition, treatment-related adverse events of grade 3 or above were higher in the group that received the transplant immediately after the triplet therapy…
Another finding from the trial was that the use of maintenance lenalidomide in both groups continuously until progression conferred substantial clinical benefit…
Study Details
In this trial, Richardson and colleagues randomly assigned 873 patients newly diagnosed with multiple myeloma to the RVD-alone group (n = 357) or the transplantation group (n = 365). All patients had received one cycle of RVD prior to randomization and then received two additional RVD cycles plus stem-cell mobilization followed by either five additional RVD cycles (the RVD-alone group) or high-dose melphalan plus ASCT followed by two additional RVD cycles (the transplantation group). Lenalidomide was administered to all patients until disease progression, unacceptable side effects, or both.
At a median follow-up of 76.0 months, the risk of disease progression or death was 53% higher among patients who received RVD alone versus the transplantation group (hazard ratio [HR], 1.53; P < .001). The median duration of PFS among patients with a high-risk cytogenetic profile was 55.5 vs 17.1 months, favoring the transplantation group.
The percentage of patients who were alive without progression at 5 years was 58.4% vs 41.6%, respectively (HR, 1.66) and median duration of response was 56.4 vs 38.9 months, also favoring transplantation (HR, 1.45).
The estimated 5-year overall survival was similar between groups: 80.7% for transplantation and 79.2% for RVD alone (HR for death, 1.10; P > .99). For patients with a high-risk cytogenetic profile, 5-year survival was 63.4% versus 54.3%, respectively…
Patients who did not undergo immediate transplant received treatment when their disease progressed with newer and active therapies, such as monoclonal antibodies and/or next-generation novel agents, he noted. Only 28% of patients used the reserve option of a transplant.
“It demonstrates the extent to which patients now have options and that we have new data to guide them in balancing the pluses and minuses of each approach,” he added.
When looking at safety, the authors noted that the most common treatment-related adverse events of grade 3 or higher occurred in 279 patients (78.2%) in the RVD-alone group and 344 patients (94.2%) in the transplantation group.
Of those patients, 60.5% and 89.9%, respectively, reported hematologic events of grade 3 or higher (P < .001).
The 5-year cumulative incidence of invasive second primary cancers was similar in both cohorts (RVD-alone group, 4.9%; transplantation group, 6.5%).”
