Just had a look at the slides the Beacon staff kindly gave links to.
It appears that although a high percentage of patients achieving stringent control had 3 year PFS, more than 1/5 did not on the KRd regime.
There is a misconception amongst patients that stringent control means an effective 'cure' or very very long remission. it would be helpful to pull together data from as many studies as possible regarding people achieving stringent control, their baseline diagnosis / health status, their initial treatment and its duration with level of response achieved prior to transplant (or otherwise), their first time to progression and over all survival.
Questions arise because such data is not very easily accessed.Yet it is clear many people are trying to determine how their outcomes might relate to base disease status, particular treatments and the depth of response to treatments.
The issue is made more complex because there are patients who never achieve normal levels of their myeloma markers, have multiple treatment regimes and survive 7-8 years or more.
We really do not know,let alone can predict, why someone with stringent control may survive no longer than someone who has always had the m-protein outside the normal range. We talk about myeloma being individual, but perhaps this is because we are focused on clinical trial outcomes rather than looking at the things I mention here. That is my opinion as an ex cancer researcher who was always aware the basic questions that are not researched or answered may hold more clues than moving ahead for elusive cures.
Forums
Re: Is relapse a foregone conclusion?
Thanks Ron for your excellent explanation of the MRD negative status. Do doctors generally take a wait and see attitude with a patient who has achieved a MRD neg. status or do they generally recommend to go ahead with a ASCT with a patient who has achieved MRD neg?
Re: Is relapse a foregone conclusion?
Hello Spirit:
I believe that the International Myeloma Working Group (IMWG) agreed on a standard for MRD only this year. It has been around a couple of years in various forms, but is relatively new. If you look at the ASH and ASCO abstracts, the first couple of studies targeting the MRD metric, and how it might be used, are just starting to publish preliminary results.
On a basic level, you can consider it a good thing, and a good place to be – somewhat better than previous best measure, which was CR or sCR. So congratulations on getting to that point.
The question you ask we actually asked our transplant doctor, and got the following response, to paraphrase: You might not be able to find the multiple myeloma cells by MRD, but that is no guarantee that they are not there. At this point, you should not cut back on any recommended treatment due to getting an MRD negative result.
So I do not think most doctors will cut back on treatment that they think should be needed (I know the sample size was 1, but he was a very prudent doctor) However, in the next few years, when study results come in, it may be the case that treatment might be able to be dialed back in the MRD negative situation. If you did so at present, it would be a judgement call, not backed up by any evidence in any studies.
In the future, just based on the recent advance in DNA research, it almost assuredly will be the case that sensitivity of MRD testing can be improved. Right now, I believe that about 1 in a million multiple myeloma cells can be detected. Researchers in the field suggest that might be improved 10 fold or 100 fold in the next couple of years. So based on more sensitive MRD testing, and if results come in the right way, it might be appropriate in the future to dial back some treatment based on MRD status, however, I don't think so today.
Good luck.
I believe that the International Myeloma Working Group (IMWG) agreed on a standard for MRD only this year. It has been around a couple of years in various forms, but is relatively new. If you look at the ASH and ASCO abstracts, the first couple of studies targeting the MRD metric, and how it might be used, are just starting to publish preliminary results.
On a basic level, you can consider it a good thing, and a good place to be – somewhat better than previous best measure, which was CR or sCR. So congratulations on getting to that point.
The question you ask we actually asked our transplant doctor, and got the following response, to paraphrase: You might not be able to find the multiple myeloma cells by MRD, but that is no guarantee that they are not there. At this point, you should not cut back on any recommended treatment due to getting an MRD negative result.
So I do not think most doctors will cut back on treatment that they think should be needed (I know the sample size was 1, but he was a very prudent doctor) However, in the next few years, when study results come in, it may be the case that treatment might be able to be dialed back in the MRD negative situation. If you did so at present, it would be a judgement call, not backed up by any evidence in any studies.
In the future, just based on the recent advance in DNA research, it almost assuredly will be the case that sensitivity of MRD testing can be improved. Right now, I believe that about 1 in a million multiple myeloma cells can be detected. Researchers in the field suggest that might be improved 10 fold or 100 fold in the next couple of years. So based on more sensitive MRD testing, and if results come in the right way, it might be appropriate in the future to dial back some treatment based on MRD status, however, I don't think so today.
Good luck.
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JPC - Name: JPC
Re: Is relapse a foregone conclusion?
I understand it is inevitable (unless something else gets you first, like old age or another infection). But when is the question. I am 6 years in remission but many people only get 2 years. It all depends on your chromosome make up and the type of myeloma you have,
Myeloma is now considered a chronic illness in the UK.
Good luck all,
peter
Myeloma is now considered a chronic illness in the UK.
Good luck all,
peter
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pjolloper
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