[Multibilly]

Transplant refusal & myeloma treatment protocols

by Multibilly on Tue Sep 23, 2014 8:40 am

One will often find two different sets of treatment protocols based on whether a patient is transplant eligible or ineligible. As an example:

http://www.msmart.org/newly%20diagnosed%20myeloma.pdf

My question is this: If a person is medically eligible for a transplant, but refuses that option, does the ineligible treatment protocol still apply to that person?

In other words, is the treatment protocol associated with transplant-ineligible patients adjusted to take into account the typical factors such as old age or poor health that would rule out a trans­plant, or is the transplant-ineligible treatment protocol just as applicable to a relatively healthy person that simply refuses a transplant?

[Dr. James Hoffman]

Re: Transplant refusal & myeloma treatment protocols

by Dr. James Hoffman on Tue Sep 23, 2014 10:49 am

I think the answer to this is that there is no one answer for all patients. I will try to give the best general answer I can.

It is true that, to some degree, the transplant-ineligible protocols may be more gentle in nature, befitting 'less well' patients. However, on the other hand, those protocols also include agents that make stem cell transplant more difficult (e.g. oral melphalan, bendamustine).

As such, for a young patient refusing transplant, one might treat with a more aggressive ('transplant-eligible' type) protocol, and avoid agents like oral melphalan to keep the transplant option open, should a patient's preference change. Over time, if transplant is clearly not going to happen, one can expand treatment to include all agents and not be so limited.

Hope this helps!