[DexMed]

Post-ASCT time to relapse, by age

by DexMed on Thu Feb 26, 2015 6:30 pm

I am currently in the induction therapy, wondering about an autologous stem cell transplant (ASCT).

1. Does genetics (FISH) test and/ or the age affect relapse after ASCT.
2. I will be 68 when ASCT is done, have del(13q) and 1q gain.

I am concerned, if the relapse comes after ASCT within a 8-10 months, is it worthwhile even going through ASCT.

As I understand, full recovery from ASCT-related issues may take as long as a year.

This topic may belong in "ASCT or not?" in the "Treatments" category.

Any suggestions, articles, or experiences will be of great help.

[Mister Dana]

Re: Post-ASCT time to relapse, by age

by Mister Dana on Thu Feb 26, 2015 7:49 pm

Dear DexMed

Search the forums for mSMART to see the Mayo recommendations based on your FISH results. But, remember, there are additional considerations beyond FISH alone.

I had the gain on chromosome 1 just like you and I am the same age as you. I did not have del(13q), but I had a scary aggressive subclone before induction. I enjoyed a complete response from induction chemo alone. Yet I went ahead with ASCT, and that was not illogical.

Why do you expect quick relapse? Can you picture a good quality of life after transplant?

Mister Dana

[finn]

Re: Post-ASCT time to relapse, by age

by finn on Fri Feb 27, 2015 12:43 pm

DexMed, you asked an excellent question: Does genetics (FISH) test and/ or the age affect relapse after ASCT?

Most of the data available is just an average of lots of different age people with different genetics and different M-spikes all pooled together. It would be great to read individual stories about how long did they stay in remission after ASCT, and know their age, genetics, and maybe even M-spike values before and post-ASCT.

Any experiences would be of great help.

[Mister Dana]

Re: Post-ASCT time to relapse, by age

by Mister Dana on Fri Feb 27, 2015 2:31 pm

Finn, you are right on the mark. I believe such studies have been done. The problem is that some patients who have had the most modern chemo treatments are still in their first remission or response. Their time to relapse is still unknown. But statisticians can use mathematical models to deal with such incomplete data and combine them with data from those whose relapse has been observed. Same thing goes for mortality data as for relapse data.

[coachhoke]

Re: Post-ASCT time to relapse, by age

by coachhoke on Fri Feb 27, 2015 3:34 pm

There is nothing that I would like more than to see a chart of what DexMed, Finn and Mister Dana are referring to:

• Age at diagnosis
• FISH markers
• Induction treatment
• Initial M-spike
• Results from induction (M-spike, CR,VGPR,.PR)
• ASCT (or no ASCT)
• Results from ASCT (M-spike, CR, VGPR, PR)
• Maintanance (or, no maintainance and type (drugs) and how long
• Length of time in remission
• Overall survival

I know everyone is different and responds differently, but isn't that what a trial study is all about? And wouldn't (shouldn't) such data influence your decision making?

[coachhoke]

Re: Post-ASCT time to relapse, by age

by coachhoke on Fri Feb 27, 2015 4:10 pm

Maybe this data could be collected from the Beacon's polls.

[Dr. Jonathan Kaufman]

Re: Post-ASCT time to relapse, by age

by Dr. Jonathan Kaufman on Fri Feb 27, 2015 11:42 pm

DexMed,

This is a very difficult situation and one that I discuss with my patients everyday.

You have asked many good questions, many of which remain unanswered and the cause of much debate among myeloma physicians.

There is a pair of large clinical trials that are ongoing that I hope will answer these questions. The French myeloma transplant group and the American bone marrow transplant clinical trial network (BMTCTN) led by Paul Richardson of the Dana Farber Cancer Institute have nearly identical studies that will help myeloma patients many years to come make the decision that you are making. In both of these studies patients are randomly assigned an early versus delayed transplant. Disease risk status, response to therapy, age and many other factors will be assessed. After the trial is complete, hopefully we will be able to more accurately inform patients based on disease risk and response to induction what is the best approach; early vs delayed transplant.

Our approach is for young (like you), otherwise healthy patients to offer transplant in first remission. We then base our post transplant maintenance based on FISH characteristics, disease risk, tolerance to induction therapy and current disease status.

We have had an institutional practice to consider delaying transplant for those patients in a relatively small fraction of newly diagnosed patients; those who have standard risk disease, an excellent response to therapy, tolerance to induction and willing to stay on post induction maintenance. We have excellent 5 year survival rates for these patients.

I hope this helps,

Jlk

[DexMed]

Re: Post-ASCT time to relapse, by age

by DexMed on Sun Mar 01, 2015 11:30 pm

Thanks Dr Kaufman, Mr Dana, Coach and Finn for your comments and suggestions.

Some additional information I found here at the Beacon includes this news article:

"Gain In chromosome 1 Negatively Affects Prognosis Only In Certain Newly Diagnosed Myeloma Patients," The Myeloma Beacon, Apr 30, 2012

Also, Dr. Shah had some relevant comments in the forum thread, "OK to start ASCT without knowing FISH test results?" (started Oct 12, 2014). He wrote:

There are differences in outcome after transplant, specifically regarding the remission duration, that can be in part guided by abnormalities seen on FISH. For example, if you had high risk features like del 17p or chromosome 1q changes, than one may worry that there will be a shortening of the remission time from 2-3 years to 9-12 months. In that setting, we still recommend transplant followed by a more aggressive maintenance therapy.

So it would not change our recommendation for ASCT. However, we do discuss the relative potential decrease in benefit with patients so they are fully aware of what may happen post transplant, and some patients may not opt for a transplant in that setting. "

It seems that, for majority of patients, ASCT is still the preferred route.