[nadia]

stem cell transplant and remission

by nadia on Tue Sep 20, 2011 11:56 pm

I was wondering for someone who has responded well to the initial treatment , what would be the benefit of doing stem cell transplant right away. We have had 2 doctors w two different opinions .. one pro transplant and one continue on maintenance wo transplant. Has there been a study that compares outcomes of such approaches w each other ?

[Dr. Edward Libby]

Re: stem cell transplant and remission

by Dr. Edward Libby on Wed Sep 21, 2011 12:19 pm

Without knowing the details regarding your case I cannot comment specifically on what is best for you. However, it has been shown that patients appear to get the same general benefit from autologous stem cell transplant used "front line" (newly diagnosed patients) as well as in 1st relapse. The general approach of most transplant centers is to perform stem cell collection and auto-transplant after 4-6 cycles of induction chemotherapy in newly diagnosed patients. This is especially true for patients who presented with "aggressive disease" e.g. pathologic fractures, kidney dysfunction/failure, severe anemia, etc. In addition, patients with high risk cytogenetics and those who do not achieve a CR with induction therapy should be considered for transplant early on.

In 2011, patients who achieve a CR with induction may have the option of collecting stem cells and saving them for a later relapse depending on their clinical situation and the preferences of the patient and their myeloma specialist.

Whenever possible, patients who may be transplant candidates in the future should have their stem cells collected after 4-6 cycles of inductiion therapy and stored for later use. This is because it gets harder and harder to collect stem cells the more treatment a patient has had.

To answer the question of whether or not a stem cell transplant needs to be done early or can be done later a very important research study is now opening in the U.S. and Europe called the IFM/DFCI 2009 trial. It will be opening at 13 centers in the U.S. and 79 centers in France, Belgium and Switzerland.