[Anonymous]

Treatment break

by Anonymous on Wed Mar 27, 2013 10:44 am

Hello everybody. My name is Michaela. I was diagnosed on May 2012. After i received 2 cycles of chemo i achieved a complete response. Then i decided to take some time out of treatment. I did a 4 color flow cytometry which was negative. Then i did an 8 color flow cytometry and was positive with 0.04% cancer cells.

So after about 3 months out of treatment i did 2 more rounds of chemo, then i did another 8 color flow cytometry which was positive again, i stayed another 3 months out of treatment and then i received a stem cell transplant.

My question is - The breaks out of treatment that i decided to have is it possible to affect me negative in the future? My main point was that when i was out of treatment i had the risk of relapse but at the same time because i didn't had continuous treatment the disease wasn't becoming resistant to the treatment because of additional clones as a result of the continuous chemo.

Best regards and good luck
Michaela

[Dr. Jason Valent]

Re: Treatment break

by Dr. Jason Valent on Wed Mar 27, 2013 12:30 pm

There is accumulating evidence that continuous treatment until treatment failure is the preferred route of treatment. This has certainly been shown in patients who are not transplant eligible. We also feel that maintenance therapy after transplant is appropriate as well.

[GeorgeLJurak]

Re: Treatment break

by GeorgeLJurak on Thu Mar 28, 2013 4:23 pm

I agree with Dr. Valent. Everything I have read over the years, states that maintenance therapy improves PFS and OS (although some conflicting studies on the OS factor). The article below should help :

Revlimid Maintenance After Stem Cell Transplantation

For second place, the surveyed physicians chose two Phase 3 studies that show Revlimid maintenance therapy following stem cell transplantation doubles progression-free survival. There was some dis­agree­ment among the physicians, though, about whether the results demonstrate that Revlimid main­te­nance has a significant overall survival benefit.

“These two papers show that low-dose Revlimid maintenance can double the length of disease response after autologous [stem cell] transplant,” said Dr. William Bensinger from the Fred Hutchinson Cancer Re­search Center. “They also show that [Revlimid maintenance is associated with] more episodes of neu­tro­penia [low white blood cell counts] and infection and also increases the risk of second primary cancers.”

Dr. Edward Libby also from the Fred Hutchinson Cancer Research Center added, “These two articles confirm the significant improvement seen in progression-free survival after transplant but were unable to show improvements in overall survival.”

“Both trials confirm that single-agent Revlimid after autologous stem cell transplant doubles the progression-free survival as compared with placebo. This finding is very important,” said Dr. Mateos. “Although no significant benefit has been observed in overall survival in the French trial, the advantage in progression-free survival is of great value.”

Dr. Heinz Ludwig from Wilhelminenspital in Vienna, Austria, on the other hand, believes Revlimid main­te­nance therapy will provide an overall survival benefit to certain myeloma patients in both studies. “Doubling progression-free survival is unprecedented, and overall survival is already superior in the CALGB study. With further follow-up a survival advantage should also become evident in the good-risk patients of the other study.”

For more information, see the CALGB and French studies in the New England Journal of Medicine, the related Beacon news, and all Beacon articles about maintenance therapy.

Hope this helps and God Bless