This is obviously a very good discussion, with lots of good contributions.
Some of you may be better up on what the data say on this subject, so I thought I would ask ...
My understanding is that (high dose chemo plus) stem cell transplantation improves the depth of response that myeloma patients can achieve versus induction therapy alone.
That is, you will get more patients achieving complete response -- and even stringent complete response -- when you perform induction therapy plus a stem cell transplant compared to just performing induction therapy.
Is this generally true?
I've seen this to be the case in one or two recent studies, but I'm not sure if it's a result that one typically sees in such studies.
Forums
Re: timing and results for proceed to 1. ASCT
Dear Shane!...lol
Yes, you did bait, and I gobbled
, only because I too have questions and doubts. No one has the answers..at present there appears to be no definitive answers, thus our choices are highly individualistic. A patient has to have faith and choose according to their lives, hope, faith and wishes for QOL.
When we talk about depth of response,(DR) we are talking about MR, (best) and/or IR's, and the jury is still out on that as well, because of the data showing PR's can have longer PFS than CR's. So that calls into question whether the parameters being measured are truly the real endpoints, despite it being the one used in most studies. Again, the boxer analogy illustrates that. IOW's DR. following induction, does not consistently correlate with overall survival.
Such that those patients who achieve sCR with induction still may not have OS despite their MR and more importantly a PR, can have as good if not better PFS than the CR patient. Moreover, if DR is defined as scR via MR or IR, how does a patient determine their personal risks and benefits of following lethal doses of chemo(HDT) with a rescue of SCT? Can the HDT give a better DR, the data to date , I've seen, does not indicate such.
When you say MORE patients reach CR post high lethal dose chemo , what data are you referring to? What was the induction therapy?
Afterall, many patients have a CR when they submit to the lethal doses. Have you seen data where that subset of patients was compared to those who did not and what their outcomes were? The data I have seen does not reflect that. Rather, it tells of those who did/didnot go one to have a CR despite the high dose therapy having higher/less OS,respectively.. Is that a higher percent? Please give me a link if you have data showing that. Again, the 'novel' agents are achieving CR in numbers previously only seen with high lethal dose chemo. Haven't seen data showing MORE patients have CR with high dose following 'novel' therapies vs high dose chemo.
Barlogie's data does NOT show increase survival. He is a pioneer for simply doing the unthinkable, tandem HDT with SCT....spare me his pioneering. Going to the brink of death once is bad enough...twice? back to back...heavenly mother of God ..whoEVER would THINK to do (lethal gas doses) such..o that's right, Barlogie, is German....
I was not aware that High dose chemo diminishes your chances of response...but that seems highly logical, given a weakened no longer intact immune system.
Ahhh the seredenpity of 'science'
I like you am hoping, wishing and praying for a more 'curative' approach. Is it in the cards, let's hope so, with the help of brilliant scientists we may get there.
Yes, you did bait, and I gobbled
, only because I too have questions and doubts. No one has the answers..at present there appears to be no definitive answers, thus our choices are highly individualistic. A patient has to have faith and choose according to their lives, hope, faith and wishes for QOL. When we talk about depth of response,(DR) we are talking about MR, (best) and/or IR's, and the jury is still out on that as well, because of the data showing PR's can have longer PFS than CR's. So that calls into question whether the parameters being measured are truly the real endpoints, despite it being the one used in most studies. Again, the boxer analogy illustrates that. IOW's DR. following induction, does not consistently correlate with overall survival.
Such that those patients who achieve sCR with induction still may not have OS despite their MR and more importantly a PR, can have as good if not better PFS than the CR patient. Moreover, if DR is defined as scR via MR or IR, how does a patient determine their personal risks and benefits of following lethal doses of chemo(HDT) with a rescue of SCT? Can the HDT give a better DR, the data to date , I've seen, does not indicate such.
When you say MORE patients reach CR post high lethal dose chemo , what data are you referring to? What was the induction therapy?
Afterall, many patients have a CR when they submit to the lethal doses. Have you seen data where that subset of patients was compared to those who did not and what their outcomes were? The data I have seen does not reflect that. Rather, it tells of those who did/didnot go one to have a CR despite the high dose therapy having higher/less OS,respectively.. Is that a higher percent? Please give me a link if you have data showing that. Again, the 'novel' agents are achieving CR in numbers previously only seen with high lethal dose chemo. Haven't seen data showing MORE patients have CR with high dose following 'novel' therapies vs high dose chemo.
Barlogie's data does NOT show increase survival. He is a pioneer for simply doing the unthinkable, tandem HDT with SCT....spare me his pioneering. Going to the brink of death once is bad enough...twice? back to back...heavenly mother of God ..whoEVER would THINK to do (lethal gas doses) such..o that's right, Barlogie, is German....
I was not aware that High dose chemo diminishes your chances of response...but that seems highly logical, given a weakened no longer intact immune system.
Ahhh the seredenpity of 'science'
I like you am hoping, wishing and praying for a more 'curative' approach. Is it in the cards, let's hope so, with the help of brilliant scientists we may get there.
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: timing and results for proceed to 1. ASCT
Hi TerryH!!
You write:
"My understanding is that (high dose chemo plus) stem cell transplantation improves the depth of response that myeloma patients can achieve versus induction therapy alone.
That is, you will get more patients achieving complete response -- and even stringent complete response -- when you perform induction therapy plus a stem cell transplant compared to just performing induction therapy."
Do you have a link for this? We already know that delayed vs. immediate lethal HDT does not change outcomes....soooo...that tells us whenever (time delayed or not) you give lethal doses, you get same outcomes. Now, why would that NOT make sense? Thus, the 100day post 'rescue' numbers.
What I have seen is that patients are achieving sCR withOUT lethal HDT. thank god.
From what I am able to read, the 'more' with HDT is NOT correlating with those who achieve MR/IR with the novel agents. In fact, it is calling into question the very idea of going forward with HDT subsequent to a MR/IR following induction with the novel agents as the numbers of CR with novel agents are comparable to what has previously ONLY been shown with HDT. So, where is the 'more'.?
How does this number compare to those who get CR during induction with 'novel' agents? Or is this data based on aklylators as induction? Makes a big difference.
Recall, the original reason for lethal dose chemo was that few patients were achieving CR without it. We are in a new era in terms of numbers of patients achieving CR with induction with novel agents. Even so, the confounding factor is that even those folks achieving PR with the novel agents have longer PFS than those with CR...how do we reconcile that?
IOW's, I speculate that the parameters being used to measure CR are not necessarily definitiive, based on not only the heterogenetity of the disease, but the very disease process itself of multiple myeloma. Just what has been measured...is it indicative of what the disease is doing or is it simply a SURROGATE parameter selected because it is what we have but does not truly reflect the disease process itself, yet it allows comparative clinical trial consistency and drug approval?
Which is a long way of saying if all you have is a hammer, everything is a nail.
Afterall:
" In addition, the time to disease progression for the early (20 months) and delayed (16 months) groups did not differ significantly."
http://www.clinicaloncology.com//ViewArticle.aspx?ses=ogst&d=Hematologic+Malignancies&d_id=149&i=ISSUE%3a+May+2012&i_id=842&a_id=20893
My choice, based on present data, is stay on whatever got you to your CR..use metronomic or maintenance therapy to keep you there, if possible. And more importantly, KNOW, that getting a PR (& being standard/low risk) with that therapy followed with maintenance lenalidomide is just as good as the 'promise' of lethal dose chemo getting you to a CR.
You write:
"My understanding is that (high dose chemo plus) stem cell transplantation improves the depth of response that myeloma patients can achieve versus induction therapy alone.
That is, you will get more patients achieving complete response -- and even stringent complete response -- when you perform induction therapy plus a stem cell transplant compared to just performing induction therapy."
Do you have a link for this? We already know that delayed vs. immediate lethal HDT does not change outcomes....soooo...that tells us whenever (time delayed or not) you give lethal doses, you get same outcomes. Now, why would that NOT make sense? Thus, the 100day post 'rescue' numbers.
What I have seen is that patients are achieving sCR withOUT lethal HDT. thank god.
From what I am able to read, the 'more' with HDT is NOT correlating with those who achieve MR/IR with the novel agents. In fact, it is calling into question the very idea of going forward with HDT subsequent to a MR/IR following induction with the novel agents as the numbers of CR with novel agents are comparable to what has previously ONLY been shown with HDT. So, where is the 'more'.?
How does this number compare to those who get CR during induction with 'novel' agents? Or is this data based on aklylators as induction? Makes a big difference.
Recall, the original reason for lethal dose chemo was that few patients were achieving CR without it. We are in a new era in terms of numbers of patients achieving CR with induction with novel agents. Even so, the confounding factor is that even those folks achieving PR with the novel agents have longer PFS than those with CR...how do we reconcile that?
IOW's, I speculate that the parameters being used to measure CR are not necessarily definitiive, based on not only the heterogenetity of the disease, but the very disease process itself of multiple myeloma. Just what has been measured...is it indicative of what the disease is doing or is it simply a SURROGATE parameter selected because it is what we have but does not truly reflect the disease process itself, yet it allows comparative clinical trial consistency and drug approval?
Which is a long way of saying if all you have is a hammer, everything is a nail.
Afterall:
" In addition, the time to disease progression for the early (20 months) and delayed (16 months) groups did not differ significantly."
http://www.clinicaloncology.com//ViewArticle.aspx?ses=ogst&d=Hematologic+Malignancies&d_id=149&i=ISSUE%3a+May+2012&i_id=842&a_id=20893
My choice, based on present data, is stay on whatever got you to your CR..use metronomic or maintenance therapy to keep you there, if possible. And more importantly, KNOW, that getting a PR (& being standard/low risk) with that therapy followed with maintenance lenalidomide is just as good as the 'promise' of lethal dose chemo getting you to a CR.
-
suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: timing and results for proceed to 1. ASCT
Hi Suzierose!
Stem cell transplants often are viewed as a kind of consolidation therapy after induction therapy. In the past when induction regimens were not as effective as they are now, it was basically a given that a stem cell transplant would deepen responses and improve both progression free and overall survival.
This is reflected, for example, in the abstract for a recent paper by Matsui, Borello, and Misiades, where the authors write "It is well established that high-dose therapy (HDT) combined with autologous stem cell transplantation (ASCT) produces superior response rates and progression-free survival compared with conventional chemotherapy in patients with multiple myeloma (multiple myeloma)."
I believe that, in regard to response rates, this statement continues to be true even in the age of induction regimens that can involve multiple novel agents. However, the only data that I've seen on the subject is from this abstract from the coming ASCO meeting:
http://abstract.asco.org/AbstView_114_101200.html
There, the authors show that 16 percent of the patients treated with a Revlimid, Velcade, dexamethasone induction regimen achieved a complete response (CR) or stringent complete response (sCR).
After the patients received a stem cell transplant, 44 percent achieved either a CR or sCR.
I don't think this is an unusual finding, but I'm curious to see if anyone knows of other recently published studies that show similar results.
Stem cell transplants often are viewed as a kind of consolidation therapy after induction therapy. In the past when induction regimens were not as effective as they are now, it was basically a given that a stem cell transplant would deepen responses and improve both progression free and overall survival.
This is reflected, for example, in the abstract for a recent paper by Matsui, Borello, and Misiades, where the authors write "It is well established that high-dose therapy (HDT) combined with autologous stem cell transplantation (ASCT) produces superior response rates and progression-free survival compared with conventional chemotherapy in patients with multiple myeloma (multiple myeloma)."
I believe that, in regard to response rates, this statement continues to be true even in the age of induction regimens that can involve multiple novel agents. However, the only data that I've seen on the subject is from this abstract from the coming ASCO meeting:
http://abstract.asco.org/AbstView_114_101200.html
There, the authors show that 16 percent of the patients treated with a Revlimid, Velcade, dexamethasone induction regimen achieved a complete response (CR) or stringent complete response (sCR).
After the patients received a stem cell transplant, 44 percent achieved either a CR or sCR.
I don't think this is an unusual finding, but I'm curious to see if anyone knows of other recently published studies that show similar results.
-
TerryH
14 posts
• Page 2 of 2 • 1, 2
Return to Treatments & Side Effects