[Multibilly]

Latest Study on Chemo-Only versus ASCT

by Multibilly on Tue Dec 10, 2013 9:05 pm

So, while trying to wade through all the papers of the ASH 2013 conference, I couldn't help but notice this one. https://myelomabeacon.org/resources/mtgs/ash2013/abs/3180/

The Beacon did cover it (excerpt below) in this link. https://myelomabeacon.org/news/2013/12/09/ash-2013-multiple-myeloma-update-day-two/

"....One poster summarized interim results of an ongoing clinical trial indicating that treatment with Revlimid and dexamethasone alone is equally effective as treatment with Revlimid and dexamethasone followed by stem cell transplantation in newly diagnosed myeloma patients (abstract). Even though the addition of stem cell transplantation resulted in a trend toward improved overall response rates (96 percent for patients undergoing stem cell transplantation versus 77 percent for patients receiving Revlimid and dexamethasone alone), it did not result in a significant difference in progression-free or overall survival between the two treatment arms".

However, I would respectfully take exception to the above statement that there wasn't a significant difference in PFS between the two treatment arms. Look at the differences in the PFS and OS times below. PFS for the non-ASCT arm was 50% (FIFTY PERCENT) longer than for those patients that had an ASCT. OS for the non-ASCT arm was also longer. Per the abstract:

Median PFS for LD+ASCT versus LD was 17.0 months (95% CI 15.5–not estimable) versus 25.2 months (95% CI 9.0–not estimable; p=0.94).

Median OS for LD+ASCT versus LD was 57.6 months (95% CI 48.0–not estimable) versus not reached (p=0.94).

I find these results to be remarkable.

[Nancy Shamanna]

Re: Latest Study on Chemo-Only versus ASCT

by Nancy Shamanna on Wed Dec 11, 2013 1:25 am

Thanks for pointing out that research abstract, Multibilly! I think that is also very interesting. It was a small study, and probably would have to be repeated, or retrospective studies done on patients who had had similar treatment programs. Apart from the fact that the ASCT did not seem to factor in favourably to the outcomes of the patients, it seems this was an induction program with only ONE chemo drug, Revlimid, plus dex (dex seems pretty standard with these treatments). So probably research scientists will also find this to be interesting and follow up on it more.

[Mark]

Re: Latest Study on Chemo-Only versus ASCT

by Mark on Wed Dec 11, 2013 3:07 pm

I agree with Nancy. My read of this study is that it shows that transplant eligible patients should get a more aggressive upfront combo since neither arm appeared to do very well IMO. I would think that the patients that did the auto had grafts that were fairly contaminated after only 4 cycles of what IMO is a weak induction therapy for patients that with an average age of around 60. REV/DEX induction seems to be a good induction therapy for older, non transplant eligible patients as opposed to younger transplant eligible patients. I doubt you will get any molecular responses (MRD negative) using only REV/DEX for 8 cycles or only 4 cycles REV/DEX followed by auto.

What I found remarkable was the REV/DEX had 2 incidences of secondary cancers including one patient with MDS and the auto arm had none. IMO A higher chance of MDS/secondary cancer is a much worse side effect than losing your hair! As mentioned earlier this is a small study but typically the therapy with most severe side effects needs to show more efficiency. In this small study REV/DEX had the single worse side effect.

"Two patients in the LD alone arm developed a secondary malignancy, including 1 patient with myelodysplastic syndrome (MDS) 13 months after the start of therapy."

[Multibilly]

Re: Latest Study on Chemo-Only versus ASCT

by Multibilly on Wed Dec 11, 2013 3:25 pm

I now see that Don at Myeloma Hope also picked up on this report.

http://myelomahope.blogspot.com/2013/12/ash-2013-skip-transplant.html