Hi Mark!
you write:
"With respect to why there were long term survivors in the earlier era, IMO long cycles of novel agents are training the cancer cells and patients immune systems to fight off Chemo. In the earlier time period patients did not do never ending cycles of therapy. I have posted this before, but I need to repost to back up my comment that the novel agents may be training the patients immune system to help the cancer survive long term:
"Multiple myeloma cancer cells thwart many of the drugs used against them by causing nearby cells to turn traitor – to switch from defending the body against disease to shielding the myeloma cells from harm – Dana-Farber Cancer Institute scientists report in the October issue of Cancer Cell."
"The researchers found that immune-system cells known as plasmacytoid dendritic cells (pDCs) essentially assume a new identity in the presence of myeloma – promoting the growth and survival of malignant myeloma cells, helping them fend off drugs, and depleting the overall strength of the immune system."
Resistance has been a problem not just for multiple myeloma but bacterial/viral infections as well. So the question becomes...do you want to take an agent that gives you longer PFS/ QOL even if it does not result in a cure?
Do long cycles make the disease manageable (QOL) and that is an acceptable risk when there is no cure?
Forums
Re: Curability of Multiple Myeloma - New Journal Article
Hi Ricardo,
Thought this was interesting.
Data comparing HDT with conventional chemotherapy with outcomes that were similiar using new 'novel' agents.
"This is the first study that compares high-dose chemotherapy with hemopoietic stem-cell support against conventional-dose chemotherapy plus new drugs, and we are pleased to see that with the actual follow-up there was no difference in response between the two arms of the study."
http://www.sciencedaily.com/releases/2010/10/101012101841.htm
"The study also included patients who were eligible for a stem cell transplant. The researchers found that these patients were able to remain on CRd treatment and achieved responses similar to or better than those observed after a stem cell transplant. This outcome delayed the need for a stem cell transplant in these patients"
http://www.sciencedaily.com/releases/2010/12/101209101511.htm
Thought this was interesting.
Data comparing HDT with conventional chemotherapy with outcomes that were similiar using new 'novel' agents.
"This is the first study that compares high-dose chemotherapy with hemopoietic stem-cell support against conventional-dose chemotherapy plus new drugs, and we are pleased to see that with the actual follow-up there was no difference in response between the two arms of the study."
http://www.sciencedaily.com/releases/2010/10/101012101841.htm
"The study also included patients who were eligible for a stem cell transplant. The researchers found that these patients were able to remain on CRd treatment and achieved responses similar to or better than those observed after a stem cell transplant. This outcome delayed the need for a stem cell transplant in these patients"
http://www.sciencedaily.com/releases/2010/12/101209101511.htm
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Curability of Multiple Myeloma - New Journal Article
Suzierose,
We may have one fundamental disagreement. I think most Doctors agree Myeloma is curable in the context of Allogeneic transplantation but there is no test that can determine with 100% certainty that a particular patient is cured. For example, Dr. Rajkumar of Mayo:
"Third, in most cases, it is probably impossible (with the possible exception of allogeneic transplantation where true complete eradication is possible for a minority of patients), unnecessary, and prohibitively toxic to attempt to eradicate all clonal plasma cells."
"Fourth, the tests used to define CR in multiple myeloma are still inadequate and often vary considerably between laboratories. Although CR defined using molecular methods with patient-specific primers after allogeneic transplantation is more prolonged,39 it cannot predict cure with certainty."
http://bloodjournal.hematologylibrary.org/content/118/12/3205.long
Dr Kenneth Anderson of Dana Farber in 2010:
" Nonetheless, long-term complete responses were observed in patients with responsive disease treated early after diagnosis. In comparative trials of patients undergoing myeloablative allogeneic versus autologous grafting, the early toxicity of the former contrasts with the ongoing risk of relapse in the latter."
" In a similar vein, studies of reduced-intensity conditioning allotransplantation now should incorporate novel therapies. Lenalidomide, as an immunomodulatory drug, has the capacity to augment GVM. Bortezomib can overcome at least some high-risk features, such as t4:14 translocation, and may also abrogate GVHD and graft rejection. Most importantly, the ability to achieve high frequency and extent of response with lenalidomide, bortezomib, and dexamethasone therapy suggests that reduced-intensity conditioning can now be tested in the setting of minimal residual disease, where maintenance lenalidomide offers the ability to augment donor GVM and achieve long-term disease-free survival."
http://www.hematology.org/Publications/Hematologist/2010/5894.aspx
Dr. Nicolaus Kroger in 2011;
"The study underlines the importance of the depth of remission and shows that achieving molecular remission as determined by myeloma-specific IgH gene rearrangements and plasma cell chimerism is associated with long-term freedom from disease and potential cure of multiple myeloma in an auto-/allo SCT approach."
https://ash.confex.com/ash/2011/webprogram/Paper42900.html
I do not think Myeloma is considered incurable in the context of Allogeneic transplantation.
Also patients that do partially T Cell depleted Allos like Dr. Kroger does (and I did) can expect this type of long term QOL according to Doctors at Mayo Clinic Arizona:
"In vivo T-cell depletion with r-ATG abrogates severe acute and chronic GVHD, and allows use of mismatched unrelated donors for allo-SCT in adult pts with otherwise incurable hematologic malignancies. Long-term survivors are generally free of severe chronic GVHD, with good quality of life. There does not appear to be an increased incidence of disease relapse, and non-relapse mortality is low. This approach is safe, effective, and considerably expands the donor pool for adult pts who require allo-SCT."
https://ash.confex.com/ash/2011/webprogram/Paper38494.html
Doctors at NIH used a different method of T Cell depletion and they also show great QOL for long term survivors:
"Most survivors beyond 5 years had an excellent performance status with no difference in physical and mental health and higher HRQL scores (P = .02) compared with population norms. Although physical and psychologic symptom distress was low, those with higher symptom distress experienced inferior HRQL. These results show that 5 or more years after T cell-depleted HSCT for hematologic malignancy most individuals survive disease free with an excellent performance status, preserved physical and psychological health, and excellent HRQL."
http://www.ncbi.nlm.nih.gov/pubmed/20302959
Since Myeloma patients have immune systems that are not functioning properly, what is wrong with high dose therapy to eliminate the old immune system to make room for a new one that may function properly? Despite what Celgene Salesman like Andrzej Jakubowiak try and tell you, therapies like Revlimid, carfilzomib and DEX do have bad side effects when used long term. Myeloma patients do not have Revlimid or carfilzomib deficiencies, even though you might not know it when you listen to the Andrzej Jakubowiak's of the world. Where does this thought come from that patients off Myeloma therapy that used high dose therapy followed by T Cell depleted Allos previously have a worse QOL than patients taking never ending cycles novel agents?
Mark
We may have one fundamental disagreement. I think most Doctors agree Myeloma is curable in the context of Allogeneic transplantation but there is no test that can determine with 100% certainty that a particular patient is cured. For example, Dr. Rajkumar of Mayo:
"Third, in most cases, it is probably impossible (with the possible exception of allogeneic transplantation where true complete eradication is possible for a minority of patients), unnecessary, and prohibitively toxic to attempt to eradicate all clonal plasma cells."
"Fourth, the tests used to define CR in multiple myeloma are still inadequate and often vary considerably between laboratories. Although CR defined using molecular methods with patient-specific primers after allogeneic transplantation is more prolonged,39 it cannot predict cure with certainty."
http://bloodjournal.hematologylibrary.org/content/118/12/3205.long
Dr Kenneth Anderson of Dana Farber in 2010:
" Nonetheless, long-term complete responses were observed in patients with responsive disease treated early after diagnosis. In comparative trials of patients undergoing myeloablative allogeneic versus autologous grafting, the early toxicity of the former contrasts with the ongoing risk of relapse in the latter."
" In a similar vein, studies of reduced-intensity conditioning allotransplantation now should incorporate novel therapies. Lenalidomide, as an immunomodulatory drug, has the capacity to augment GVM. Bortezomib can overcome at least some high-risk features, such as t4:14 translocation, and may also abrogate GVHD and graft rejection. Most importantly, the ability to achieve high frequency and extent of response with lenalidomide, bortezomib, and dexamethasone therapy suggests that reduced-intensity conditioning can now be tested in the setting of minimal residual disease, where maintenance lenalidomide offers the ability to augment donor GVM and achieve long-term disease-free survival."
http://www.hematology.org/Publications/Hematologist/2010/5894.aspx
Dr. Nicolaus Kroger in 2011;
"The study underlines the importance of the depth of remission and shows that achieving molecular remission as determined by myeloma-specific IgH gene rearrangements and plasma cell chimerism is associated with long-term freedom from disease and potential cure of multiple myeloma in an auto-/allo SCT approach."
https://ash.confex.com/ash/2011/webprogram/Paper42900.html
I do not think Myeloma is considered incurable in the context of Allogeneic transplantation.
Also patients that do partially T Cell depleted Allos like Dr. Kroger does (and I did) can expect this type of long term QOL according to Doctors at Mayo Clinic Arizona:
"In vivo T-cell depletion with r-ATG abrogates severe acute and chronic GVHD, and allows use of mismatched unrelated donors for allo-SCT in adult pts with otherwise incurable hematologic malignancies. Long-term survivors are generally free of severe chronic GVHD, with good quality of life. There does not appear to be an increased incidence of disease relapse, and non-relapse mortality is low. This approach is safe, effective, and considerably expands the donor pool for adult pts who require allo-SCT."
https://ash.confex.com/ash/2011/webprogram/Paper38494.html
Doctors at NIH used a different method of T Cell depletion and they also show great QOL for long term survivors:
"Most survivors beyond 5 years had an excellent performance status with no difference in physical and mental health and higher HRQL scores (P = .02) compared with population norms. Although physical and psychologic symptom distress was low, those with higher symptom distress experienced inferior HRQL. These results show that 5 or more years after T cell-depleted HSCT for hematologic malignancy most individuals survive disease free with an excellent performance status, preserved physical and psychological health, and excellent HRQL."
http://www.ncbi.nlm.nih.gov/pubmed/20302959
Since Myeloma patients have immune systems that are not functioning properly, what is wrong with high dose therapy to eliminate the old immune system to make room for a new one that may function properly? Despite what Celgene Salesman like Andrzej Jakubowiak try and tell you, therapies like Revlimid, carfilzomib and DEX do have bad side effects when used long term. Myeloma patients do not have Revlimid or carfilzomib deficiencies, even though you might not know it when you listen to the Andrzej Jakubowiak's of the world. Where does this thought come from that patients off Myeloma therapy that used high dose therapy followed by T Cell depleted Allos previously have a worse QOL than patients taking never ending cycles novel agents?
Mark
-
Mark
Re: Curability of Multiple Myeloma - New Journal Article
Hi Mark!
No fundamental difference here.
I agree that allo SCT provides best hope of cure today. And I have always admired your courage to undergo that process.
"Since Myeloma patients have immune systems that are not functioning properly, what is wrong with high dose therapy to eliminate the old immune system to make room for a new one that may function properly?"
If we are talking allo, there is none. Unfortunately, as you know auto's do not make room for a new immune system, they simply obliterated the old and you wind up with an even weaker diseased system along with organ damage, courtesy of the high dose chemotherapy.
"Despite what Celgene Salesman like Andrzej Jakubowiak try and tell you"
hehehehehe, it cracks me up everytime you write this. You do not know how hard I work to refrain from making this type of commentary in the forum. as much as I agree with you. The sites sponsors do not encourage the detailed commentary I could make...worse the patients defend big pharma..thus I refrain.
"therapies like Revlimid, carfilzomib and DEX do have bad side effects when used long term. Myeloma patients do not have Revlimid or carfilzomib deficiencies, even though you might not know it when you listen to the Andrzej Jakubowiak's of the world"
lol, lol...c'mon I can agree about Jakubowiak..but... Myeloma patients also do not have adequate levels of Nk killer cells nor Tp53 which would induce apoptosis of neoplastic cells that are proliferating, where as those drugs provide additional cellular support to wipe out the nasty cancererous clones do effectively. As far as side effects go, multiple myeloma patients have done well with bortezomib which has been around for at least 10 years, without major Grade 3 side effects in the majority of patients other than PN, lenalidomide we may have to worry about SPM but that has only been seen in less than 2% of patients and the odds are better that a patient will die of multiple myeloma first without the drug. Carfilzomib has a better safety profile than bortizomib and given that it has a different SAR (structure activity relationship) there is less likelihood that will change. There has been some whispers, but no evidence to date, of renal issues with PI's.
I would not trade the safety/side effect profile of any of these agents relative to the old mustargen gas, aklylators and heavy metal agents which are so toxic that it should be inhumane to administer them even to animals. But then doctors only 'recommend' therapy it is the patient (uniformed) who decides to submit to the suggestion. right?
" Where does this thought come from that patients off Myeloma therapy that used high dose therapy followed by T Cell depleted Allos previously have a worse QOL than patients taking never ending cycles novel agents?"
Did I write that? If so, it was likely a typo. The patients who receive allos have a good life because they DO get a new immune system but if there is GVHD they don't, Patients with autos, may or may not have good QOL since they must wait for their immune system ( having been obliterated) to restore itself to normal function. That can be a long road and may not occur at all.
Many patients with auto have ongoing major organ damage of the liver, bladder, heart and lungs due to the lethal toxic doses they endured along with cataracts, impotence and infections, just to name a few.
Most patients do not even ask about these though since they think the stem cells are the therapy, they fail to ask what are the toxic effects of the true therapy, as they labor under the delusion of word 'transplant'..and no one bothers to tell them, when they have ongoing issues that it is from the lethal doses of mustargen gases and aklylators, instead it is all attributed to 'recovery' from the transplant...what a farce. Yet, most patients can tell you alllllll about those stem cells they got back and how they work. Just pathetic. The absolute worse part is that the HD chemotherapy followed by stem cell infusion fails 50% of the time.
Truthfully, the thing that sticks in my craw the most is that despite my having 5 of the 6 negative chromosomal abnormalities, 2 doctors" recommended" autoSCT to me as 'therapy' before I got to NIH. Imagine my surprise to not only learn they were actually recommending lethal toxic doses chemotherapy but because I did the research, I learned that patients with my profile have dismal outcomes from HDT. Just imagine, if I had been so UNinformed that I had followed their 'recommendation' solely based on them being medical experts. Ha! So, I take seriously this whole 'recommending' an auto stem cell transplant as 'therapy' that the medical community and patients use. Physicians should be required to say that the high dose chemotherapy is the treatment and that damage to the bone marrow is the SIDE EFFECT necessitating stem cells to be re-infused.
In the end of course, each patient weighs the risk and benefits for themselves, and it is between them and their God what choice they decide since, as Jobs said, although everyone wants to go to heaven, no one wants to die to get there.
So, overall, I believe we fundamentally agree that allogenic transplants do offer the best potential for a cure, presently.
There are new hopes on the horizon, I believe such as:
What are your thoughts about these clinical trials? The first is similar to what you did, I believe and then there is a new approach with the second trial.
http://www.ncbi.nlm.nih.gov/pubmed/22160384?dopt=Abstract
http://clinicaltrials.gov/ct2/show/NCT00924326
Does NK expansion offer route to cure
http://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2008-H-0186.html
No fundamental difference here.
I agree that allo SCT provides best hope of cure today. And I have always admired your courage to undergo that process.
"Since Myeloma patients have immune systems that are not functioning properly, what is wrong with high dose therapy to eliminate the old immune system to make room for a new one that may function properly?"
If we are talking allo, there is none. Unfortunately, as you know auto's do not make room for a new immune system, they simply obliterated the old and you wind up with an even weaker diseased system along with organ damage, courtesy of the high dose chemotherapy.
"Despite what Celgene Salesman like Andrzej Jakubowiak try and tell you"
hehehehehe, it cracks me up everytime you write this. You do not know how hard I work to refrain from making this type of commentary in the forum. as much as I agree with you. The sites sponsors do not encourage the detailed commentary I could make...worse the patients defend big pharma..thus I refrain.
"therapies like Revlimid, carfilzomib and DEX do have bad side effects when used long term. Myeloma patients do not have Revlimid or carfilzomib deficiencies, even though you might not know it when you listen to the Andrzej Jakubowiak's of the world"
lol, lol...c'mon I can agree about Jakubowiak..but... Myeloma patients also do not have adequate levels of Nk killer cells nor Tp53 which would induce apoptosis of neoplastic cells that are proliferating, where as those drugs provide additional cellular support to wipe out the nasty cancererous clones do effectively. As far as side effects go, multiple myeloma patients have done well with bortezomib which has been around for at least 10 years, without major Grade 3 side effects in the majority of patients other than PN, lenalidomide we may have to worry about SPM but that has only been seen in less than 2% of patients and the odds are better that a patient will die of multiple myeloma first without the drug. Carfilzomib has a better safety profile than bortizomib and given that it has a different SAR (structure activity relationship) there is less likelihood that will change. There has been some whispers, but no evidence to date, of renal issues with PI's.
I would not trade the safety/side effect profile of any of these agents relative to the old mustargen gas, aklylators and heavy metal agents which are so toxic that it should be inhumane to administer them even to animals. But then doctors only 'recommend' therapy it is the patient (uniformed) who decides to submit to the suggestion. right?
" Where does this thought come from that patients off Myeloma therapy that used high dose therapy followed by T Cell depleted Allos previously have a worse QOL than patients taking never ending cycles novel agents?"
Did I write that? If so, it was likely a typo. The patients who receive allos have a good life because they DO get a new immune system but if there is GVHD they don't, Patients with autos, may or may not have good QOL since they must wait for their immune system ( having been obliterated) to restore itself to normal function. That can be a long road and may not occur at all.
Many patients with auto have ongoing major organ damage of the liver, bladder, heart and lungs due to the lethal toxic doses they endured along with cataracts, impotence and infections, just to name a few.
Most patients do not even ask about these though since they think the stem cells are the therapy, they fail to ask what are the toxic effects of the true therapy, as they labor under the delusion of word 'transplant'..and no one bothers to tell them, when they have ongoing issues that it is from the lethal doses of mustargen gases and aklylators, instead it is all attributed to 'recovery' from the transplant...what a farce. Yet, most patients can tell you alllllll about those stem cells they got back and how they work. Just pathetic. The absolute worse part is that the HD chemotherapy followed by stem cell infusion fails 50% of the time.
Truthfully, the thing that sticks in my craw the most is that despite my having 5 of the 6 negative chromosomal abnormalities, 2 doctors" recommended" autoSCT to me as 'therapy' before I got to NIH. Imagine my surprise to not only learn they were actually recommending lethal toxic doses chemotherapy but because I did the research, I learned that patients with my profile have dismal outcomes from HDT. Just imagine, if I had been so UNinformed that I had followed their 'recommendation' solely based on them being medical experts. Ha! So, I take seriously this whole 'recommending' an auto stem cell transplant as 'therapy' that the medical community and patients use. Physicians should be required to say that the high dose chemotherapy is the treatment and that damage to the bone marrow is the SIDE EFFECT necessitating stem cells to be re-infused.
In the end of course, each patient weighs the risk and benefits for themselves, and it is between them and their God what choice they decide since, as Jobs said, although everyone wants to go to heaven, no one wants to die to get there.
So, overall, I believe we fundamentally agree that allogenic transplants do offer the best potential for a cure, presently.
There are new hopes on the horizon, I believe such as:
What are your thoughts about these clinical trials? The first is similar to what you did, I believe and then there is a new approach with the second trial.
http://www.ncbi.nlm.nih.gov/pubmed/22160384?dopt=Abstract
http://clinicaltrials.gov/ct2/show/NCT00924326
Does NK expansion offer route to cure
http://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2008-H-0186.html
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Curability of Multiple Myeloma - New Journal Article
Hi Mark, I agree with you that allos seem to offer the best hope of a cure. However, as we have previously discussed insurance companies are loath to cover them as they are considered experimental. You are lucky you were able to convince your insurance company to cover yours. I am sure the bill for an allo without insurance coverage is astronomical so self-financing is not an option. As for Jakubowiak, he may have conflicts. However, NONE of the NIH doctors do and they have the same basic CRd trial he does. I trust Dr. Landgren more than anyone and if you read his research or watch his videos, he never has a conflict to declare. I am sure many of the posters here who go to the NIH would attest to that.....Suzierose? Terry
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Curability of Multiple Myeloma - New Journal Article
Hi Terry!
Darn tootin'!! I can attest to that.
Darn tootin'!! I can attest to that.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Curability of Multiple Myeloma - New Journal Article
Terry,
Great to hear that the carfilzomib trial is working for you! It is a great relief when you know your Induction is working.
I've mentioned before that I would go to the NIH for an opinion if I lived closer. Also, a Doctor named Dan Fowler works at the NIH and he is very well respected in the "Allo world". I have a great deal of respect for Dr. Landgren as well. I certainly do not think Doctors that use carfilzomib are bad Doctors. I am very impressed with the fast responses and the immunophenotypic responses patients got in the trials. I hope it gets approved. I would use carfilzomib in a short cycle if I needed it.
Everybodys experience is different. The reason I continually point out the Conflict of Interest statements of doctors is my own experience. I think a part of the reason allos are considered experimental for myeloma is the myeloma doctors themselves. The insurance companies point to research that they put out. Allos are not considered experimental in other blood cancers. In reality, most blood cancer patients all have the same basic problem - our immune systems are not functioning properly. Much of the research on allos apply across all blood cancers. Take note of Dr. Andersons quote above about incorporating the novel agents into the allo process. I see no evidence any doctors here in the US are doing that. I do see doctors in Europe doing it. Not that there is likely much disagreement about this but another research paper came out about Allo transplants that said this:
" In multivariate analysis >1 prior ASCT (OS:HR=2,81, p=0,001;PFS:HR=2,89, p=0,000) and "RIC" (OS:HR=2,00, p=0,022;PFS:HR=2,09, p= 0,010) could be confirmed as independent risk factors. Patients reaching at least a PR prior to HSCT and lacking the latter two risk factor reached an OS of 60% and PFS of 50% with a follow-up till 17,5 years."
"Summarizing the results, we established >1 prior ASCT as an independent risk factor for subsequent HSCT, contradictory to the use of double ASCT as standard therapy, especially in younger patients. Furthermore we saw moderate TRM rates after "myeloablative" HSCT, resulting in a significant better outcome compared to the RIC regimen. This observations raise the question if early and myelablative HSCT might be the key to cure multiple myeloma."
https://www.eventure-online.com/eventure/publicAbstractView.do?id=190223&congressId=5650
I know I am in a very small group that thinks the continuos therapy approach is actually moving us further away from a cure. Even Dr. Barlogie and Dr. Berenson can agree that continuous therapy is a good thing.
Mark
Great to hear that the carfilzomib trial is working for you! It is a great relief when you know your Induction is working.
I've mentioned before that I would go to the NIH for an opinion if I lived closer. Also, a Doctor named Dan Fowler works at the NIH and he is very well respected in the "Allo world". I have a great deal of respect for Dr. Landgren as well. I certainly do not think Doctors that use carfilzomib are bad Doctors. I am very impressed with the fast responses and the immunophenotypic responses patients got in the trials. I hope it gets approved. I would use carfilzomib in a short cycle if I needed it.
Everybodys experience is different. The reason I continually point out the Conflict of Interest statements of doctors is my own experience. I think a part of the reason allos are considered experimental for myeloma is the myeloma doctors themselves. The insurance companies point to research that they put out. Allos are not considered experimental in other blood cancers. In reality, most blood cancer patients all have the same basic problem - our immune systems are not functioning properly. Much of the research on allos apply across all blood cancers. Take note of Dr. Andersons quote above about incorporating the novel agents into the allo process. I see no evidence any doctors here in the US are doing that. I do see doctors in Europe doing it. Not that there is likely much disagreement about this but another research paper came out about Allo transplants that said this:
" In multivariate analysis >1 prior ASCT (OS:HR=2,81, p=0,001;PFS:HR=2,89, p=0,000) and "RIC" (OS:HR=2,00, p=0,022;PFS:HR=2,09, p= 0,010) could be confirmed as independent risk factors. Patients reaching at least a PR prior to HSCT and lacking the latter two risk factor reached an OS of 60% and PFS of 50% with a follow-up till 17,5 years."
"Summarizing the results, we established >1 prior ASCT as an independent risk factor for subsequent HSCT, contradictory to the use of double ASCT as standard therapy, especially in younger patients. Furthermore we saw moderate TRM rates after "myeloablative" HSCT, resulting in a significant better outcome compared to the RIC regimen. This observations raise the question if early and myelablative HSCT might be the key to cure multiple myeloma."
https://www.eventure-online.com/eventure/publicAbstractView.do?id=190223&congressId=5650
I know I am in a very small group that thinks the continuos therapy approach is actually moving us further away from a cure. Even Dr. Barlogie and Dr. Berenson can agree that continuous therapy is a good thing.
Mark
-
Mark
Re: Curability of Multiple Myeloma - New Journal Article
Suzierose,
Those trials are interesting. I would consider this one as well.
http://bethesdatrials.cancer.gov/clinical-research/search_detail.aspx?ProtocolID=NCI-04-C-0055
One downside to the one I posted is that patients need a sibling donor. That makes this less applicable to the general population. I think these type of immunotherapy trials should be used in a patients first CR. That is when allos work best, so I think these types of therapies should be given their best chance to work since they are such a leap forward IMO. I am glad that relapsed patients get the opportunity for these therapies as well. I think one of the issues is that some immunotherapies are tried on relapsed patients only. A good example is that DLI's work best when used to get Molecular responses in patients in CR as opposed to when they are used in patients that have progressive disease.
Mark
Those trials are interesting. I would consider this one as well.
http://bethesdatrials.cancer.gov/clinical-research/search_detail.aspx?ProtocolID=NCI-04-C-0055
One downside to the one I posted is that patients need a sibling donor. That makes this less applicable to the general population. I think these type of immunotherapy trials should be used in a patients first CR. That is when allos work best, so I think these types of therapies should be given their best chance to work since they are such a leap forward IMO. I am glad that relapsed patients get the opportunity for these therapies as well. I think one of the issues is that some immunotherapies are tried on relapsed patients only. A good example is that DLI's work best when used to get Molecular responses in patients in CR as opposed to when they are used in patients that have progressive disease.
Mark
-
Mark
Re: Curability of Multiple Myeloma - New Journal Article
Hi Mark,
That is an interesting trial.
One of my primary objectives is to avoid anthracycline and alkylator chemotherapy that is part of the protocol. I would sooo like to design a clinical trial that does not include those classes of drugs being used to wipe out the bone marrow.
And while I am duly impressed with your success, I do not have your courage when it comes to allo SCT.
When it comes to side effects and risks there is no free lunch for multiple myeloma patients. We just have to try to stay one step ahead and hope that the side effect /risk profile is not as unforgiving as the inexorable progression of the disease.
That is an interesting trial.
One of my primary objectives is to avoid anthracycline and alkylator chemotherapy that is part of the protocol. I would sooo like to design a clinical trial that does not include those classes of drugs being used to wipe out the bone marrow.
And while I am duly impressed with your success, I do not have your courage when it comes to allo SCT.
When it comes to side effects and risks there is no free lunch for multiple myeloma patients. We just have to try to stay one step ahead and hope that the side effect /risk profile is not as unforgiving as the inexorable progression of the disease.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Curability of Multiple Myeloma - New Journal Article
Dear all,
Regarding the study, they focused on the patients treated in the earlier time period, because they have very long-term follow-up on that group of patients. As such, they are able to say that if you remain in CR for 12+ years, you are not going to relapse (you are functionally cured). They did NOTstate that outcomes and chance of functional cures is lower in the modern era of myeloma therapy. A CR with old school therapy is not better than a CR with modern therapy. In fact, the number of patients in a sustained CR is likely to be higher given the fact that more people are getting into CR these days.
Pete V.
Regarding the study, they focused on the patients treated in the earlier time period, because they have very long-term follow-up on that group of patients. As such, they are able to say that if you remain in CR for 12+ years, you are not going to relapse (you are functionally cured). They did NOTstate that outcomes and chance of functional cures is lower in the modern era of myeloma therapy. A CR with old school therapy is not better than a CR with modern therapy. In fact, the number of patients in a sustained CR is likely to be higher given the fact that more people are getting into CR these days.
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
24 posts
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