[wa7gwl]

Allogeneic Transplant or Maintenance Therapy

by wa7gwl on Thu May 26, 2011 11:08 pm

Doctor:

I am interested in your professional opinion concerning the two options above. I was diagnosed with multiple myeloma a year ago and received a NCR with induction therapy. (I'm 58 years old and otherwise in good health.) I then underwent an autologous transplant without complications in December of last year. I relapsed in late February of this year and developed a few plasmacytomas before I could even start maintenance therapy. I'm currently on Velcade, Revlimid and Dexamethasone. I had a very rapid and positive response to this new therapy. The plasmacytomas shrunk and disappeared within about 2 1/2 weeks. M spike is now .1 I'm about halfway through this regiment and my oncologist is extremely pleased with my response.

I have, however, received conflicting opinions regarding whether or not an allogeneic transplant is worth the risks or if I should rely on the novel agents for maintenance therapy and forego the transplant. I know there is no right or wrong answer per se, but I would be interested in your thoughts. I have one sibling who is about to be tested. If she is not a match, is there a higher risk using an unrelated donor and would that change the equation in your minds? There does seem to be agreement that a second autologous transplant for me would not be beneficial.

Thank you for your reply.

Frank

[Dr. David Siegel]

Re: Allogeneic Transplant or Maintenance Therapy

by Dr. David Siegel on Fri May 27, 2011 9:15 pm

You are asking a question that is more philosophy than medicine. Allo transplants are dangerous things. Unrelated allos, perhaps, slightly more so. The issue is, in a pt with what is proving to be difficult disease, do you take on such a risky procedure hoping to be cured. Even with an allo, cure is a long-shot and that has to be understood. Having said that, the longer you wait to do an allo, the less likely it is to work. There are a number of investigators, including Dan Fowler at the NIH, who are developing excellent strategies for doing allo transplants in multiple myeloma.

While I in general agree with your statement that a second auto is not likely to be beneficial, there are more aggressive conditioning regimens that might offer better disease control as a prelude to the transplant.

I think most multiple myeloma people would agree that you "should rely on the novel agents for maintenance therapy and forego the transplant" but this is as I said above, a philosophical and not a medical question.

[Pamela Lussier]

Re: Allogeneic Transplant or Maintenance Therapy

by Pamela Lussier on Mon Jun 06, 2011 2:21 pm

Because I have had to look into a allo/kidney transplant.(which has been done on about 12 people). I have had to look at the stats for this particular type of transplant. (Mass General Hospital Boston clinical trial for the double transplant)The mortality rate for the allo stem cell transplant alone is listed in some materials as 25%. So the extra danger really has to be considered. I have been looking at the clinical trial for 7 people who have done this double transplant and 4 got their multiple myeloma back (1 even died of multiple myeloma and another died from the allo transplant complications), so I don't know if that is any type of permanent solution and if it is worth the risk. I don't know how the multiple myeloma can come back when you have another persons bone marrow. But this is what happened.

Pamela Lussier