What I wish I knew about Multiple Myeloma treatments 25 years later...

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Pre-Autologous Stem Cell Transplant Chemotherapy- More is Not better.

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“…additional pre-Autologous Stem Cell Transplant salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.”

Fascinating. The Autologous Stem Cell Transplant is the standard-of-care for newly diagnosis multiple myeloma patients as well as for other blood cancers.  ASCT are given to the majority of MM patients to achieve the longest possible overall survival (OS).

The study linked and excerpted below was authored, in part, by the oncologist who managed my autologous stem cell transplant- Hillard Lazarus M.D. The article below was published in 2014. I had my ASCT in December of 1995. Dr. Lazarus had 19 years from my ASCT to the publication of the study below to learn about ASCT in MMers.

What is known about autologous stem cell transplantation for multiple myeloma patients and survivors?

I’m not a board certified oncologist. I’m just a long-term MM survivor who’s learned a lot about cancer survival through research and personal experience. Chemotherapy and radiation are toxic. Though it may be necessary for MMers at times, the less toxicity the better. Its that simple. Less is more in MM.

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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Impact of pretransplant therapy and depth of disease response before autologous transplantation for multiple myeloma.

“Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response.

We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010.

These patients were then divided into 2 groups:

  • those who received additional salvage chemotherapy before ASCT (n = 324) and
  • those who had no additional salvage chemotherapy immediately before ASCT (n = 215).

Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%).

On multivariate analysis there was no impact of pretransplant salvage chemotherapy on

  • treatment-related mortality,
  • risk for relapse,
  • progression-free survival, or
  • overall survival.

In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.”

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