Let me say again when I think an allo transplant should be done: in FIRST COMPLETE RESPONSE. I would not do one any other time so the study you refer to is backing up my point:
You wrote,
Furthermore, there's no guarantee that you'll get that curative response from an allo transplant if you do survive. According to a study titled "Long-term survival after allogeneic stem cell transplantation for advanced stage multiple myeloma." (Br J Haematol. 2014 Aug;166(4):616-8. doi: 10.1111/bjh.12881. Epub 2014 Apr 4.), the majority of those who received allo-SCTs did relapse at some point. Sixteen out of 37 did not achieve beyond a partial response."
In my opinion, it is extremely dangerous to do an allo transplant at any time other than first CR. I do not consider an allo as a curative procedure if not done in first CR. Allos are not good at getting you to remission - but they can keep you there permanently.
You also wrote:
That's illustrated by the fourth article you reference (Biol Blood Marrow Transplant. 2006 Jun;12(6):648-55.) They started out looking to interview 309 patients who had received allo-SCTs. After 6 months, there were only 137 who could be interviewed. As is stated in the article, "In the TCD HRQL study, most interviews are missing because of patient illness or death." . They don't state whether these folks died as a direct result of the treatment, from advancing disease, or from some other cause, but that's not a heartening statistic."
Blood cancer patients die that do not do allo transplants. You would have to know more about disease status, risk characteristics etc of the patients to know if that is good or bad. Centers can lose followup with patients as well.
Note the difference in outcomes in this study between patients that do allos upfront or at relapse. The OS at 5 years is 77%.
When comparing patients who received a planned allogeneic transplantation upfront rather than later in the disease course, the former had a significantly better 2 year OS and PFS: 77% versus 43% (p<0.001) and 57% versus 28% (p=0.022) respectively (Figure 1). Patients in partial remission or better at the time of transplant also had a superior 2 year PFS (49% versus 24%, p=0.04), with no significant difference in OS. Patients who developed chronic GvHD had an improved OS (HR 0.65, 95% CI 0.29-1.44) and PFS (HR 0.77, 95% CI 0.34-1.71), however this did not reach statistical significance."
S Gerull et al, "Allogeneic Transplantation for Multiple Myeloma – the Swiss Experience," ASH 2011 Annual Meeting, Abstract 3112
The planned upfront looks right on par with Mayo clinic data of non-allo patients in this Beacon article. Also note the early mortality in this study.
Over the entire course of the study, 13 percent of the patients died within the first year of diagnosis. However, the one-year mortality rate significantly decreased during the study, from 16 percent for patients diagnosed between 2001 and 2005, to 10 percent for patients diagnosed between 2006 and 2010.
Patients who received one ore more novel agents as part of their initial therapy had lower early mortality compared to those who did not (8 percent versus 19 percent, respectively)"
"Survival Of Multiple Myeloma Patients Significantly Increases Over Last Decade," The Myeloma Beacon, Nov 1, 2011.
Early mortality is not zero in the non-allo setting.
Unfortunately allos do not work well in a relapsed setting and I would not consider one in a relapsed setting, but you are correct that it is when most patients do them.
Good luck moving forward and hopefully you will be one the 10% of patients that never relapses after an auto!
Mark
