Hello,
I am in my second cycle of CyBorD [Cytoxan (cyclophosphamide), Velcade, and dexamethasone] with an autologous stem cell transplant scheduled for this September. I am in complete remission already.
It feels counter-intuitive to keep taking more chemo when the goal of CR prior to transplant has already been achieved. Is it alright to consider fewer cycles than 4 pre-transplant?
Thanks.
Forums
10 posts
• Page 1 of 1
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corinnastevenson - Name: Corinna Stevenson
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2010
- Age at diagnosis: 39
Re: Why do more treatment cycles if you've reached CR?
Hi Corinna,
I'm glad that you are already reaching excellent levels with just a couple of cycles. Certainly, it is definitely a good thing to discuss with your doctor whether you need to do more cycles or not before transplant, or even having a transplant at all. These are all things that are important to consider, as well as asking your doctor to lay out the rationale for why or why not.
Having said that, there are now gradations to complete responses, which indicates the level of sensitivity of the tests being done. The most stringent is the molecular CR, or mCR. So, a rationale for continuing with the plan would have that while you are in CR, you may not have achieved mCR, for example.
Best wishes,
Alex
I'm glad that you are already reaching excellent levels with just a couple of cycles. Certainly, it is definitely a good thing to discuss with your doctor whether you need to do more cycles or not before transplant, or even having a transplant at all. These are all things that are important to consider, as well as asking your doctor to lay out the rationale for why or why not.
Having said that, there are now gradations to complete responses, which indicates the level of sensitivity of the tests being done. The most stringent is the molecular CR, or mCR. So, a rationale for continuing with the plan would have that while you are in CR, you may not have achieved mCR, for example.
Best wishes,
Alex
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Why do more treatment cycles if you've reached CR?
My husband reached "CR "after 1-2 cycles as well with RVD. However, we went to ASCT to try to "deepen" the response. He reached CR in June but continued on till September and transplanted in November. He was 43 at the time of transplant.
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Why do more treatment cycles if you've reached CR?
Hi Corinna,
You should speak with your doctor and see what his/her long term strategy is with respect to your treatment. You should ask your doctor what your risk profile is. Fast responses like the one you had can be associated with high risk disease.
"Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease, likely through different mechanisms. For the shallow responders, prospective trials should assess if a change in therapeutic management will alter the outcome of these pts. The rapid deep responders also appear represent a different high-risk biology, emphasizing the fact that pts with high-risk disease often have excellent initial responses, but poor long term outcomes."
http://meetinglibrary.asco.org/content/118060-132
Mark
You should speak with your doctor and see what his/her long term strategy is with respect to your treatment. You should ask your doctor what your risk profile is. Fast responses like the one you had can be associated with high risk disease.
"Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease, likely through different mechanisms. For the shallow responders, prospective trials should assess if a change in therapeutic management will alter the outcome of these pts. The rapid deep responders also appear represent a different high-risk biology, emphasizing the fact that pts with high-risk disease often have excellent initial responses, but poor long term outcomes."
http://meetinglibrary.asco.org/content/118060-132
Mark
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Mark
Re: Why do more treatment cycles if you've reached CR?
This is a very good question and has largely been answered above.
There are limits in the standard serum and urine testing in picking up on monoclonal proteins (which are the surrogate for myeloma cells still alive). However we know that we have not killed all myeloma cells with standard therapy even if a complete response is achieved.
We do know that the better the response to initial treatment, generally, the longer the duration of remission. So the additional cycles of therapy even with "undetectable" disease is trying to make the response even better and hopefully prolong remission duration and survival.
There are limits in the standard serum and urine testing in picking up on monoclonal proteins (which are the surrogate for myeloma cells still alive). However we know that we have not killed all myeloma cells with standard therapy even if a complete response is achieved.
We do know that the better the response to initial treatment, generally, the longer the duration of remission. So the additional cycles of therapy even with "undetectable" disease is trying to make the response even better and hopefully prolong remission duration and survival.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Why do more treatment cycles if you've reached CR?
The study posted is a bit confusing as Q1 and Q4 also had the most patients with high risk cytogenetics. Couldn't the cytogenetics be the reason for decreased OS not the response rate?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Why do more treatment cycles if you've reached CR?
Hi Blair77,
The sentence prior to what I posted is:
"In a multivariate analysis, quartile 1 and 4 of serum M-protein response and the high-risk FISH were INDEPENDENT risk factors associated inferior OS."
If you do not understand what multivariate analysis is you can "Google" as multivariate analysis is commonly used in clinical abstracts/studies.
The point of my posting this is not to say that having a rapid response as defined in this study is always related with poor outcomes. I get the impression that some patients think that a rapid response as defined in this study is related with a good outcomes and that is not necessarily the case.
Mark
The sentence prior to what I posted is:
"In a multivariate analysis, quartile 1 and 4 of serum M-protein response and the high-risk FISH were INDEPENDENT risk factors associated inferior OS."
If you do not understand what multivariate analysis is you can "Google" as multivariate analysis is commonly used in clinical abstracts/studies.
The point of my posting this is not to say that having a rapid response as defined in this study is always related with poor outcomes. I get the impression that some patients think that a rapid response as defined in this study is related with a good outcomes and that is not necessarily the case.
Mark
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Mark
Re: Why do more treatment cycles if you've reached CR?
Corinna,
At least from reading only the abstract, the study appears to concern only with the quality of response after cycle 1.
At least from reading only the abstract, the study appears to concern only with the quality of response after cycle 1.
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Why do more treatment cycles if you've reached CR?
I asked myself and my doctor the same question. I had two rounds of VDT-PACE and went into CR. However, the plan was to have a tandem transplant plus consolidation and maintenance. I asked why continue if I've reached the only measurable outcome? My doctor (Guido Tricot) basically said we haven't gotten them all. The sleeper cells are still there. Having full faith in Dr. Tricot, I said ok, lets have no regrets.
That was 6.5 years ago. Still in CR and have been off all drugs, except Aredia, for 5 years. QOL is good. But, the measurable standard of CR is unchanged ... so I assume we got a few more of the bad guys
That was 6.5 years ago. Still in CR and have been off all drugs, except Aredia, for 5 years. QOL is good. But, the measurable standard of CR is unchanged ... so I assume we got a few more of the bad guys
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DougC
Re: Why do more treatment cycles if you've reached CR?
Great news, DougC!
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
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