[SCT Survivor]

Maintenance therapy after second stem cell transplant

by SCT Survivor on Tue Apr 12, 2016 11:05 am

My wife is about 40 days out from her second autologous stem cell transplant. She was in remission for 4 years following the first stem cell transplant without maintenance therapy. Velcade-Revlimid-Decadron was used prior to her first stem cell transplant with remarkable success and Kyprolis-Revlimid-Decadron was used prior to the second transplant with similar success.

Her transplant surgeon and primary oncologist agree maintenance therapy is indicated following this second transplant, but are not ready to commit to a specific regimen until the disease is restaged at Day 100.

So, our question is general in nature, not necessarily specific to her case.

Does anyone have experience with maintenance therapy who might share their experience?

Second, is anyone aware of any studies or statistics relative to the pros and cons of various regimens, or results that have been achieved with various regimens?

[Tandem ASCT Bob]

Re: Maintenance therapy after second stem cell transplant

by Tandem ASCT Bob on Mon Apr 18, 2016 10:03 am

My case is not altogether the same. I have had tandem autologous stem cell transplants three years ago and been on 10 mg of Revlimid ever since as part of a clinical trial. My numbers bottomed out and stayed flatline ever since.

I am looking forward to getting off my Revlimid soon, although I am a little afraid off what the future may hold. The side effects are not bad, although tedious and relentless – just like multiple myeloma.

Good luck,
Bob

[JPC]

Re: Maintenance therapy after second stem cell transplant

by JPC on Mon Apr 18, 2016 12:23 pm

Hello SCT Survivor,

Here is a post to the recent CalGB study on Revlimid maintenance published last year:

http://meetinglibrary.asco.org/content/145418-156

In that study, with no maintenance, progression was 27 months after the ASCT. With maintenance, progression was 53 months. That is a pretty significant difference. Reading to the overall survival (OS) data, with maintenance, OS was not yet reached, while without maintenance, it was 73 months. The expectation is that with maintenance, the OS would be considerably better.

I am not aware of a study for your exact situation, no maintenance after first ASCT, but maintenance after second ASCT. Of note, however, your wife definitely did do a lot better than the medium with about 48 months time to progression, without maintenance. Also, the KRD combo is typically more active than the RVD combo.

It's impossible to predict on an individual basis. One general trend is that duration of second remission is generally shorter than first remission. However, in your case, I think that the general idea would be that adding something extra that your wife did not get before (the Revlimid maintenance), that would give you a better chance to try and get at least the same remission as the first time. Arguably, there are other options as well, including Velcade, Ninlaro (ixazomib, and Empliciti (elotuzumab) for maintenance, but those are less often used than Revlimid.

Good luck.

[rgrusin]

Re: Maintenance therapy after second stem cell transplant

by rgrusin on Wed Dec 28, 2016 9:53 am

My wife is in a similar situation, although her disease is nonsecretory. She is 28 days out from her second autologous transplant. She got six years of remission from the first one without maintenance. She received four cycles of Kyprolis, Revlimid, and dexamethasone before this second transplant. We are eagerly waiting until Day 100 to see if the second one worked. Her doctor is recommending (or will recommend) Revlimid maintenance therapy after Day 100.

What did you and your wife decide to do? We're interested as well in the balance of side effects from the Revlimid with the extended length of the remission. We're also wondering if there is any data on survival after the disease comes back again: Does maintenance lengthen overall survival after the second relapse, or does the removal of one of the "weapons" from the "arsenal" shorten overall survival?

Thanks.