We've receive several suggestions that we let forum participants know about this write-up of an interesting debate that recently took place between Dana-Farber's Dr. Kenneth Anderson and Sloan-Kettering's Dr. Sergio Giralt.
The myeloma experts debated whether or not it makes sense for myeloma patients to have a stem cell transplant as part of their "upfront" (initial) therapy, or to wait to have a transplant at relapse.
The debate was summarized in this recent article in Oncology Times,
"Upfront Transplant in Multiple Myeloma? Clinicians' Choice Split", Oncology Times, Sep 27, 2014 (full text of article)
and also in this later article:
"Experts Debate the Need for Upfront vs Late Stem Cell Transplant in Multiple Myeloma," The ASCO Post, Nov 1, 2014 (full text of article)
Dr. Giralt argued in favor of upfront transplantation, while Dr. Anderson took the position that it's less and less clear that upfront transplantation should be the favored treatment strategy for all transplant eligible patients.
There also are quotes in the Oncology Times article from Dr. Ola Landgren, who is the new Chief of the Myeloma Service at Sloan-Kettering.
Are there any particular points made by the debate participants, or quotes from the article, that you find especially interesting? How would you summarize the positions the two experts took?
Forums
6 posts
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Re: Anderson & Giralt debate about early vs. late SCTs
Thanks MB for the thread! My treatment plan fell into the 42 percent voting and I was quite similar to the 50 year old candidate list of conditions. As I move forward after my early ASCT, I wonder if I made the right choice. I'm still quite fatigued and worry when I'll get back to the strength I was able to achieve after initial induction therapy.
Thanks again for the discussion.
Kully
Thanks again for the discussion.
Kully
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kullybunnny1 - Name: Kully
- Who do you know with myeloma?: me
- When were you/they diagnosed?: August 2013
- Age at diagnosis: 48
Re: Anderson & Giralt debate about early vs. late SCTs
Thank you Beacon Staff for posting this! My husband and I have a very strong interest in it, and hope that eventually Dr. Anderson's opinion proves best (not all newly diagnosed patients necessarily need early transplant). However, I think more time needs to pass to know it with better certainty.
After reading other Beacon posts from those describing their transplants for us, and knowing my husband's non-transplant experiences, I think both transplants and use of novel agents (to delay ASCT) both have their own drawbacks. My observation is that early ASCT appears to have compressed a lot of the problems into a shorter time span, while using novel agents to delay ASCT have the problems occur over a longer time.
My husband was in the Phase I/II study for Carfilzomib (Kyprolis) / Revlimid / dexamethasone for newly diagnosed multiple myeloma patients. Beginning in June 2011, he received the carfilzomib infusions over 24 months at the University of Michigan. The infusions required significant commitment on his part: the first 8 cycles he was infused 2 days per week for 3 weeks (one week off per cycle), and the remaining cycles he was infused every other week for 2 days per week.
We live 3.5 hours from the University of Michigan (one way), so there was significant traveling, time away from home, and expense. Not to mention treacherous winter roads in northern Michigan! Fortunately, he could manage his workload around his infusions and his co-workers helped cover for him when needed.
My husband still experienced almost all of the textbook complications from the multiple myeloma disease and also some complications from the drugs used to treat it (DVT and reduced pulmonary function). There were some very difficult times early in his treatment, but he's been doing extremely well for a long time now. His pulmonary problems cleared up once the carfilzomib stopped and he used Lovenox for a year after the DVT diagnosis. He has stem cells in storage, just in case.
Since his infusions ended, my husband has had the usual labs, 24 hour urine, BMB, and also flow cytometry. At his quarterly checkup last week, there were still no signs of the disease. He's on 15 mg Revlimid maintenance now. Fingers and toes are crossed!
Chris M.
After reading other Beacon posts from those describing their transplants for us, and knowing my husband's non-transplant experiences, I think both transplants and use of novel agents (to delay ASCT) both have their own drawbacks. My observation is that early ASCT appears to have compressed a lot of the problems into a shorter time span, while using novel agents to delay ASCT have the problems occur over a longer time.
My husband was in the Phase I/II study for Carfilzomib (Kyprolis) / Revlimid / dexamethasone for newly diagnosed multiple myeloma patients. Beginning in June 2011, he received the carfilzomib infusions over 24 months at the University of Michigan. The infusions required significant commitment on his part: the first 8 cycles he was infused 2 days per week for 3 weeks (one week off per cycle), and the remaining cycles he was infused every other week for 2 days per week.
We live 3.5 hours from the University of Michigan (one way), so there was significant traveling, time away from home, and expense. Not to mention treacherous winter roads in northern Michigan! Fortunately, he could manage his workload around his infusions and his co-workers helped cover for him when needed.
My husband still experienced almost all of the textbook complications from the multiple myeloma disease and also some complications from the drugs used to treat it (DVT and reduced pulmonary function). There were some very difficult times early in his treatment, but he's been doing extremely well for a long time now. His pulmonary problems cleared up once the carfilzomib stopped and he used Lovenox for a year after the DVT diagnosis. He has stem cells in storage, just in case.
Since his infusions ended, my husband has had the usual labs, 24 hour urine, BMB, and also flow cytometry. At his quarterly checkup last week, there were still no signs of the disease. He's on 15 mg Revlimid maintenance now. Fingers and toes are crossed!
Chris M.
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Chris M.
Re: Anderson & Giralt debate about early vs. late SCTs
Thanks for the link to an interesting debate. It's nice to see that the experts are debating some of the same topics that we've debated here in the Beacon forums. 
I was happy to see the IMF/DFCI 2009 “Determination” trial mentioned. That trial should give us snapshot data to determine whether early auto SCT is necessary with today's novel agents (bortezomib, lenalidomide, and dexamethasone). Speaking of that trial, I think I read somewhere during the summer that preliminary results would be published in September, but I have not seen any mention of these results. Has anyone else seen them?
As novel agents continue to improve, the need for auto SCTs will diminish. The myeloma specialist leading the "Determination" trial at the myeloma center where I am treated said that he expects that auto SCTs will be rare, if they are done at all, for multiple myeloma patients in 10 years. And we had that conversation 1 1/2 years ago, so the clock has been ticking.
If this debate and vote had occurred 5 years ago, I bet the vote would have swung heavily in favor of early SCT. If it is held again 5 years from now, I bet the result will be the opposite. So let's enjoy the debate now while we can.
I was happy to see the IMF/DFCI 2009 “Determination” trial mentioned. That trial should give us snapshot data to determine whether early auto SCT is necessary with today's novel agents (bortezomib, lenalidomide, and dexamethasone). Speaking of that trial, I think I read somewhere during the summer that preliminary results would be published in September, but I have not seen any mention of these results. Has anyone else seen them?
As novel agents continue to improve, the need for auto SCTs will diminish. The myeloma specialist leading the "Determination" trial at the myeloma center where I am treated said that he expects that auto SCTs will be rare, if they are done at all, for multiple myeloma patients in 10 years. And we had that conversation 1 1/2 years ago, so the clock has been ticking.
If this debate and vote had occurred 5 years ago, I bet the vote would have swung heavily in favor of early SCT. If it is held again 5 years from now, I bet the result will be the opposite. So let's enjoy the debate now while we can.
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Anderson & Giralt debate about early vs. late SCTs
So I am a pro-auto SCT example, I guess. Two SCT's, one in 2004 about 8 months after diagnosis, the next in 2009 about 6 months after the first relapse.
I am now relapsing again, it looks like, so we get to see what happens to a post 11-year patient.
No idea where the tea leaves stand on a third transplant. My onc has brought it up, but I have no idea. Anyone else going through this now?
Thalidomide / dex / Zometa (I've had so much, a bone marrow biopsy is like a cage match in the octagon) was the frontline therapy back in 2004.
Pretty much just Revlimid after the 2008 relapse and as maintenance since the 2009 transplant.
Back in December 2003 I did not think I would be typing this in late 2014.
Allen B
I am now relapsing again, it looks like, so we get to see what happens to a post 11-year patient.
No idea where the tea leaves stand on a third transplant. My onc has brought it up, but I have no idea. Anyone else going through this now?
Thalidomide / dex / Zometa (I've had so much, a bone marrow biopsy is like a cage match in the octagon) was the frontline therapy back in 2004.
Pretty much just Revlimid after the 2008 relapse and as maintenance since the 2009 transplant.
Back in December 2003 I did not think I would be typing this in late 2014.
Allen B
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allenbonslett - Who do you know with myeloma?: Me
- When were you/they diagnosed?: 12/2003
- Age at diagnosis: 43
Re: Anderson & Giralt debate about early vs. late SCTs
I was diagnosed August 2013 with multiple myeloma. I have chosen not to have a stem cell transplant (SCT). I am currently on dexamethasone 40 mg once a week, Revlimid 25 mg, and Velcade injection 2x a month
I am taking hydromorphone for minimal pain ... especially in the morning.
I am doing okay with this treatment. I was walking a lot until my foot flared up with arthritis. I am seeing an orthopedic to get that pain under control so that I can walk more again.
Best to all you with multiple myeloma.
Louise
I am taking hydromorphone for minimal pain ... especially in the morning.
I am doing okay with this treatment. I was walking a lot until my foot flared up with arthritis. I am seeing an orthopedic to get that pain under control so that I can walk more again.
Best to all you with multiple myeloma.
Louise
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Louise Naczek
6 posts
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