Interesting paper from 2014 ASH. I have seen doctors on Youtube videos and posters in forums say they think high dose chemotherapy makes it more difficult to use therapy in the future due to lowered bone marrow function from the high dose chemotherapy. This study shows just the opposite. According to this study, it is never ending cycles of "novel" agents causing that problem and that a third auto actually improves bone marrow function for relapsed myeloma patients.
"High-dose chemotherapy followed by autologous stem cell transplant (ASCT) has been the mainstay of first-line treatment in multiple myeloma for nearly two decades. As the majority of patients (pts.) will experience relapse, we continuously are in need of effective salvage strategies such as the era of the “novel agents” is offering. The “next generation” compounds such as pomalidomide or carfilzomib significantly improve prognosis. However, virtually all drug combinations need to be delivered continuously through (subsequent) disease progression, thereby contributing to exhaustion of bone marrow function. This in turn leads to compromised full-dose treatment, which would be necessary to conquer refractory disease. Given these challenges and considering a long interval since the initial exposure to melphalan (Mel) a further autotransplant seems reasonable. Whether a third autotransplant still is effective in patients who have initially received tandem ASCT and may overcome therapy-induced exhausted bone marrow function is unclear. Therefore, we assessed the outcomes of pts. receiving a third melphalan-based salvage ASCT (ASCT3). "
"Conclusions OUR ANALYSIS INDICATES THAT SALVAGE ASCT AT LATE RELAPSE IS FEASIBLE AND ASSOCIATED WITH A 6 MOS.’ ADDITIONAL PFS INTERVAL BUT ALSO CONTRIBUTE TO IMPROVED HEMATOPOIETIC FUNCTION. PTS. MAY THUS TOLERATE FURTHER CONVENTIONAL LINES OF TREATMENT what is suggested by an OS of 30 mos. IN ADDITION, ASCT OFFERS A SUBSTANTIAL TREATMENT-FREE INTERVAL WHEN COMPARED TO EITHER “NEXT GENERATION” NOVEL DRUG. In this series, unfavourable cytogenetics were associated with a trend for worse PFS but not OS outcomes, meanwhile being double refractory was linked with clearly inferior OS. Interestingly, median duration of storage of their autografts of 52 mos. (range, 1 – 154) did not impair engraftment after salvage transplant."
S Strifler et al, "Third Autologous Salvage Transplant at Late Myeloma Relapse Is Associated with Favourable Overall Survival and Contributes to Improvement of Exhausted Bone Marrow Function," ASH 2014 Abstract 3988.
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