[Annamaria]

Length of remissions

by Annamaria on Fri Dec 05, 2014 4:30 am

It is my understanding that only the first remission can be long, sometimes several years, while the subsequent ones tend to be shorter. Has anyone seen the quantitative data on this? If so, I would like to look at them.

[mikeb]

Re: Length of remissions

by mikeb on Fri Dec 05, 2014 12:52 pm

Hi Annamarie,
This is a question I've been wondering about recently myself. So your raising it here prompted me to take some time this morning to try to find an answer by searching the web and by looking through some conference materials I have.

I was unsuccessful.

I am sure that there must be some papers out there reporting data in the form of median Progression Free Survival time for first response vs. second response vs. third response, etc. But I couldn't find data reported that way. Perhaps that just shows my lack of skill as a web researcher.

Sorry I don't have a better answer, and hoping someone else does...

Mike

[Ron Harvot]

Re: Length of remissions

by Ron Harvot on Fri Dec 05, 2014 2:01 pm

I also could not find anything specific. I too, however, have the same impression that each relapse produces a shorter period of remission or stability until the next progression.

I think that part of that is in reading the studies that exist on new treatments. You read about trials or studies in which the participants have all had relapses and have had several lines of prior treatment already. The results often are that the new combination will have given a minority percentage of the patients (usually less than 50%) a few months of progression-free survival. Those types of studies can be misleading since the patient population they are testing are often those with very advanced disease in which all the front line therapy has already been tried and failed.

I am not sure that helps much in answering the underlying question. It may be slanting the judgment and causing us to make wrong assumptions.

[Nancy Shamanna]

Re: Length of remissions

by Nancy Shamanna on Fri Dec 05, 2014 2:47 pm

I have heard more than once at patient conferences, that in regards to stem cell transplants, the next remission from one is about half of the length of time as the previous one. So after a certain point, the effort and recovery from having a stem cell transplant is counter productive to quality of life. But of course, there are other ways of getting treatments that are not as difficult as that.

It's a really good question I suppose, although I think that many patients actually do not get a really solid remission, but may have to switch from one therapy to another since the first one may no longer be very effective.

The search for a cure and better quality of life is really ongoing! And I guess I could say that we need the newer treatments in Canada, too. Hopefully 2015 will be a good year for that.

[Salzmav]

Re: Length of remissions

by Salzmav on Sat Dec 06, 2014 7:35 am

Hi,

I asked my haemotologist why the length of remissions are shorter each time. The reason is that the chemo targets fast growing cells. Most myeloma cells divide rapidly. But a few don't, and also a few are 'resistant', so to speak. So the myeloma cells that are left consist of more slow dividers and 'resistant' cells. And hence there are more of them to repopulate the bone marrow, and less fast growers.

So the second time the remission is shorter, as less multiple myeloma cells are killed. This is also why it is very rare indeed to have more than 2 transplants - as it is a case of diminishing returns - in the end the chemo, doesn't work, and by the time you've got over the treatment, you are practically out of 'remission'.

Myeloma is such an individual thing, it's all very idiosyncratic. This may be of some assistance - Long-term outcome of patients with multiple myeloma after autologous hematopoietic cell transplantation and nonmyeloablative allografting

And this may be of help too - Second Autologous Stem Cell Transplantation as Salvage Therapy for Multiple Myeloma: Impact on Progression-Free and Overall Survival

[ivanm]

Re: Length of remissions

by ivanm on Fri Dec 12, 2014 10:58 am

I am not aware of any quantitative data on this, but it is generally true (although there are various studies that delve into the science of why myeloma becomes more resilient with time and every subsequent treatment). As Ron points out, the conclusion comes from analyzing the various studies for relapsed patients, who have worse PFS than newly diagnosed patients do.

That said, there is no hard and fast rule here. I can give myself as an example. I was diagnosed when I was 37 and I obtained a CR via RVD (Revlimid, Velcade, dexamethasone) in the first 3-4 months after my diagnosis. I did an auto transplant as consolidation. Subsequent to the transplant, I had a very quick relapse and I did a few cycles of Velcade plus radiation. That put me again in CR and I have been in CR since. I am on 15 mg Revlimid maintenance.

As you see, my second remission was longer than my first. That said, my expectation is that my next relapse will be a game changer and I expect, statistically, with what is available right now as relapse therapy, around 30 months as a median. Say if I use elotuzumab and pomalidomide as a sole therapy. That is aside from any trial CART, allo, or a combination of antibody and second generation inhibitors that I can do, which could theoretically give me a longer PFS. That's at least how I see things.

In too many words, once you relapse, things are not looking great, but it's not the end of the road, as my example shows above.

Good luck to you and everyone else.

[BeatMyeloma]

Re: Length of remissions

by BeatMyeloma on Fri Dec 12, 2014 2:48 pm

Interestingly enough, my mother's doctor at Mayo told her that, while they used to think that second remissions following auto SCTs were always less than the first, they now know that isn't true – they can be just as long, or longer.