[ClassicKate]

Goal of induction therapy prior to ASCT?

by ClassicKate on Fri Jan 03, 2014 8:43 pm

What was the goal of your induction therapy prior to autologous stem cell transplantation (ASCT)? I have always thought it would be CR, in other words, as close as possible to "zero" on key multiple myeloma labs (M spike, light chains, heavy chain).

I was recently told that as close as possible to "zero" is not the goal of induction because that is the job of the melphalan during the transplant process.

Also, did any of you have (for lack of a better word) "enhanced" induction prior to ASCT? For example, I understand that some myeloma centers recommend Revlimid 50 mg for 3 days just prior to Day 0 of the ASCT?

[Multibilly]

Re: Goal of induction therapy prior to ASCT?

by Multibilly on Fri Jan 03, 2014 11:03 pm

I always thought the general idea of induction was to try to get to something like VGPR using a relatively benign process, with the primary goal being to stabilize one's symptoms before HD melphalan. Once, you've stabilized the symptoms, you then go through the HD melpahalan treatment to "scorch the earth" in order to get to CR.

That's the way my doc explained it to me.

I never understood why they even call an autologous SCT a "transplant", since you aren't transplanting anything...but that's another story

[Eric Hansen]

Re: Goal of induction therapy prior to ASCT?

by Eric Hansen on Fri Jan 03, 2014 11:06 pm

Hi, Kate- the answer to this in my experience with ASCT is that they want as close to zero as they can get before the transplant. However, in my case, my M-spike was 1.2 after induction therapy, so they gave me 4 days of VCAD chemo in the hospital. Still 1.2. So they tried Hyper CVAD chemo for 5 days .... still 1.2. I was getting really concerned. But they went ahead with the transplant, and at the 3-month check it was still 1.2. Now, a year post transplant, with Revlimid 10 mg for maintenance, my M-spike is down to 0.6 and no issues.

So, the short answer I guess, is that they go for the best result but take what they get. And the transplant in my case at least, was definitely worthwhile-

Best of luck to you,
Eric

[darnold]

Re: Goal of induction therapy prior to ASCT?

by darnold on Sun Jan 05, 2014 1:07 pm

Hi Kate. I was told that the purpose of the induction therapy was to reduce the myeloma as much as possible prior to the SCT, plus get my pain and nascent kidney damage under control. I was at about a 95% reduction after 6 months of medication and was then taken off of meds until the transplant.

Multibilly, I had to laugh at your comment at the use of the term "transplant". I've had the same thought for the past 4 years!