Hello,
Hoping that Dr. Berenson or other doctors who answer questions on this forum might be able to answer this.
We are currently deciding between a tandem autologous transplant treatment option and an autologous/mini-allogeneic transplant option. My husband is on induction therapy currently, after being diagnosed with most advanced stage but low-risk myeloma in April 2010, he is 39.
What is the benefit in one vs. the other?
Does one have a better success rate?
What about long-term complications and side effects?
Quality of life in the long term is most important to us, along of course with survival and beating myeloma! However, it seems the more we speak with people the more there are cautions about allogeneic transplants and the long term potential side effects and complications. Then again, the graft vs. myeloma effect sounds quite good! However, with tandem auto transplants there is a long consolidation therapy afterwards according to most protocols we've seen, and with that longer term therapy there can be a lot of side effects as well.
Any thoughts on this issue would be much appreciated, thanks!
Forums
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carlinandjames - Name: Carlin and James
- Who do you know with myeloma?: James
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 39
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
I am not a believer in a single- let alone a double-transplant. The recent studies are again showing no survival benefit with transplant vs. continuation of conventional treatment. Obviously, I then would not believe that two is better than one.
Most recent studies have shown no difference in terms of success. There are certainly multiple long-term complications, the most significant of which is on the quality of life overall. In addition, these high-dose therapy procedures do permanent damage on the bone marrow microenvironment (i.e. the “soil” in which normal bone marrow is supposed to grow).
I would certainly be reluctant to have you undergo this procedure. I hope that you understand that the transplant procedure requires you to go through a high-dose chemotherapy which kills off any good cells in your body before you get transplanted. This is one of the reasons I do not recommend transplants in general. It is not a replacement for chemotherapy.
Most recent studies have shown no difference in terms of success. There are certainly multiple long-term complications, the most significant of which is on the quality of life overall. In addition, these high-dose therapy procedures do permanent damage on the bone marrow microenvironment (i.e. the “soil” in which normal bone marrow is supposed to grow).
I would certainly be reluctant to have you undergo this procedure. I hope that you understand that the transplant procedure requires you to go through a high-dose chemotherapy which kills off any good cells in your body before you get transplanted. This is one of the reasons I do not recommend transplants in general. It is not a replacement for chemotherapy.
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Dr. James Berenson - Name: James R. Berenson, M.D.
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Dr. Berenson's position on transplants is well known. Unfortunately he did not answer your question.
We underwent Tandem SCTs and many people get two Autos if you consider the 2nd transplant when it comes back. Little Rock does them as an upfront therapy. Here is a link to their Fall 2009 Briefing showing some of their survival projections.
http://myeloma.uams.edu/news/Myeloma%20Briefing%20Newsletter%20Fall%202009.pdf
I am not a doctor or in the medical profession. But I would be hard pressed to go an Allo route with a Low Risk Myeloma. In terms of your question, the Mini Allo I believe is still pretty new to make a comparison as you have asked. In my observations and consultations with doctors, Allo's are last resort - there is nothing else. The morbidity is significantly higher for the full Allo. I don't have a lot of peripheral information about the mini, though I have found it intriguing. I know no one with Myeloma that starts with an Allo.
Quality of life with change no matter what you do now. There is no looking back. How you cope with that, and how much your impacted by Myeloma and its treatment has been my focus and it is a view point that has worked well for us. Whatever you decide, novel therapies, transplants, nothing, it won't be an easy road, but it is doable. My husband worked through his whole treatment and continues to work full time. He is fatigued and has edema from the maintenance therapy (not to mention the SCTs do take their toll).
Good Luck.
http://www.caringbridge.org/visit/davidpuente
We underwent Tandem SCTs and many people get two Autos if you consider the 2nd transplant when it comes back. Little Rock does them as an upfront therapy. Here is a link to their Fall 2009 Briefing showing some of their survival projections.
http://myeloma.uams.edu/news/Myeloma%20Briefing%20Newsletter%20Fall%202009.pdf
I am not a doctor or in the medical profession. But I would be hard pressed to go an Allo route with a Low Risk Myeloma. In terms of your question, the Mini Allo I believe is still pretty new to make a comparison as you have asked. In my observations and consultations with doctors, Allo's are last resort - there is nothing else. The morbidity is significantly higher for the full Allo. I don't have a lot of peripheral information about the mini, though I have found it intriguing. I know no one with Myeloma that starts with an Allo.
Quality of life with change no matter what you do now. There is no looking back. How you cope with that, and how much your impacted by Myeloma and its treatment has been my focus and it is a view point that has worked well for us. Whatever you decide, novel therapies, transplants, nothing, it won't be an easy road, but it is doable. My husband worked through his whole treatment and continues to work full time. He is fatigued and has edema from the maintenance therapy (not to mention the SCTs do take their toll).
Good Luck.
http://www.caringbridge.org/visit/davidpuente
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Lori P
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Thanks for answering the question, Lori! Your husband's successful treatment is a perfect example of how one size doesn't fit all in the world of myeloma therapy. Pat
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Pat Killingsworth - Name: Pat Killingsworth
- Who do you know with myeloma?: I am a multiple myeloma patient
- When were you/they diagnosed?: April, 2007
- Age at diagnosis: 51
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Has anyone had their stem cells frozen for possible later use? And then used them? Thanks
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Kansas - Name: Rex
- Who do you know with myeloma?: self
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 61
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
I had stem cells collected for two transplants at one time. The first transplant was a week or so after collection, the second transplant was several months later. So, they were frozen. This is very common practice. I don't think there is much risk of them "spoiling" (for use of a better term). If I had not had the second transplant so soon after the first (as part of a clinical trial, they would have been kept (and frozen) indefinitely.
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lyndaclark - Who do you know with myeloma?: Self
- When were you/they diagnosed?: August 2005
- Age at diagnosis: 49
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Why did you wait 5 years to have a transplant?
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URBAN
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Dr. James Berenson wrote:Most recent studies have shown no difference in terms of success. There are certainly multiple long-term complications, the most significant of which is on the quality of life overall. In addition, these high-dose therapy procedures do permanent damage on the bone marrow microenvironment (i.e. the “soil” in which normal bone marrow is supposed to grow).
Where can I access this research? I am in the middle of making a decision to have a single stem cell transplant and would like to read the most current information and investigations. Thank you.
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URBAN
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
Dear URBAN,
Two recent studies presented at the American Society of Clinical Oncology meeting showed that treatment with novel myeloma therapies may be as effective as autologous stem cell transplantation:
Revlimid-dexamethasone induction followed by melphalan-prednisone-Revlimid therapy
Revlimid-Velcade-dexamethasone therapy
These latest studies highlight that stem cell transplantation may not be necessary. Certain protocols involving novel agents may be as effective. However, there are also many studies that show stem cell transplantation is highly effective. Feel free to read some of our articles about various stem cell transplant protocols:
https://myelomabeacon.org/tag/stem-cell-transplant/
In particular, you may be interested in:
Treatment trends for multiple myeloma - autologous stem cell transplants
Revlimid maintenance therapy after stem cell transplantation
The following forum discussion is also highly recommended. Several myeloma patients who were in the process of making the same decision as you explain their dilemma. Other myeloma patients explain how they decided whether to undergo a transplant or to use novel agents instead. And Dr. Craig Hofmeister explains some of the data supporting the use of stem cell transplantation:
https://myelomabeacon.org/forum/transplant-or-novel-drug-t110.html
Two recent studies presented at the American Society of Clinical Oncology meeting showed that treatment with novel myeloma therapies may be as effective as autologous stem cell transplantation:
Revlimid-dexamethasone induction followed by melphalan-prednisone-Revlimid therapy
Revlimid-Velcade-dexamethasone therapy
These latest studies highlight that stem cell transplantation may not be necessary. Certain protocols involving novel agents may be as effective. However, there are also many studies that show stem cell transplantation is highly effective. Feel free to read some of our articles about various stem cell transplant protocols:
https://myelomabeacon.org/tag/stem-cell-transplant/
In particular, you may be interested in:
Treatment trends for multiple myeloma - autologous stem cell transplants
Revlimid maintenance therapy after stem cell transplantation
The following forum discussion is also highly recommended. Several myeloma patients who were in the process of making the same decision as you explain their dilemma. Other myeloma patients explain how they decided whether to undergo a transplant or to use novel agents instead. And Dr. Craig Hofmeister explains some of the data supporting the use of stem cell transplantation:
https://myelomabeacon.org/forum/transplant-or-novel-drug-t110.html
Re: Tandem Autologous Transplant vs. Auto/Mini-Allo Combination
To URBAN: Sorry, I'm just now seeing how you may have misunderstood my post. My stem cells weren't saved for five years. You must have based this on my date of diagnosis. I have actually been in complete remission now for about 4-1/2 years. My stem cells were used for my two transplants within 6 months. I was just mentioning that I know they can be frozen for much longer periods of time. Unfortunately, I used up all that were collected when I had the two transplants.
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lyndaclark - Who do you know with myeloma?: Self
- When were you/they diagnosed?: August 2005
- Age at diagnosis: 49
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