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Allo transplant cures?
I keep reading that an allo transplant can be "curative", but has it actually ever cured someone of multiple myeloma?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Allo transplant cures?
Hi Blair,
The longest remission I have ever read about was 30 years plus. It was a patient of Dr. Michael Cavo. He discussed it briefly in an IMF publication.
"Returning for a moment to the subject of your first allo patient, does she remain disease-free after more than 30 years?
Yes, she is actually cured of myeloma. While there are still a lot of caveats concerning allo transplantation in myeloma, a small fraction of patients benefit from this procedure and are long-term, disease-free survivors. Similarly, approximately one fifth of patients treated with ASCT remain in CR more than 10 years after high-dose therapy, and their number is likely to increase in the future as a result of recent incorporation of novel agents into transplantation."
http://myeloma.org/pdfs/MT808_d2web.pdf
As Dr Cavo mentions, only a small fraction of myeloma patients are candidates for allo transplant. It will be great when curative therapy is available for older myeloma patients.
Mark
The longest remission I have ever read about was 30 years plus. It was a patient of Dr. Michael Cavo. He discussed it briefly in an IMF publication.
"Returning for a moment to the subject of your first allo patient, does she remain disease-free after more than 30 years?
Yes, she is actually cured of myeloma. While there are still a lot of caveats concerning allo transplantation in myeloma, a small fraction of patients benefit from this procedure and are long-term, disease-free survivors. Similarly, approximately one fifth of patients treated with ASCT remain in CR more than 10 years after high-dose therapy, and their number is likely to increase in the future as a result of recent incorporation of novel agents into transplantation."
http://myeloma.org/pdfs/MT808_d2web.pdf
As Dr Cavo mentions, only a small fraction of myeloma patients are candidates for allo transplant. It will be great when curative therapy is available for older myeloma patients.
Mark
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Mark
Re: Allo transplant cures?
Hi Blair,
Mark summed it up very nicely, allos can cure. Does that mean you are going to know that you are cured of myeloma? - not necessarily. One way to determine if a person is cured is to know what mutations they had in the first place at the DNA level. This would involve sequencing the specific genes and designing pieces of DNA that can be used diagnostically later on after treatment. The problem with myeloma is that you may have more than one type of mutation and that over time the mutations can change. Another way to possibly tell would be time - how long has the person stayed in remission. I never found out what mutations caused my myeloma but I have had an allo and am in remission and have been for a year now. Am I cured? I don't know, I guess time will tell. The most important thing for me is knowing the paraprotein level is undetected whereas prior to the allo no chemical ever reduced it below 16 g/L.
Libby
Mark summed it up very nicely, allos can cure. Does that mean you are going to know that you are cured of myeloma? - not necessarily. One way to determine if a person is cured is to know what mutations they had in the first place at the DNA level. This would involve sequencing the specific genes and designing pieces of DNA that can be used diagnostically later on after treatment. The problem with myeloma is that you may have more than one type of mutation and that over time the mutations can change. Another way to possibly tell would be time - how long has the person stayed in remission. I never found out what mutations caused my myeloma but I have had an allo and am in remission and have been for a year now. Am I cured? I don't know, I guess time will tell. The most important thing for me is knowing the paraprotein level is undetected whereas prior to the allo no chemical ever reduced it below 16 g/L.
Libby
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LibbyC - Name: LibbyC
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2009
- Age at diagnosis: 43
Re: allo transplant cures?
I would love to see a number representing cures from transplants, a percentage, of the ones done. I have never seen that number.
Re: Allo transplant cures?
Hi Dee,
Many factors can effect how well an allo transplant works. A Doctor can estimate an individuals patients chance, but no one number is accurate and applicable to all patients. Here is a general estimate Dr. William Bensinger gave in a 2007 paper.
"Stem-cell transplantation from allogeneic donors may be curative for 10–20% of patients with chemotherapy-resistant, refractory hematologic malignancies, and for up to 80% of patients who are transplanted in remission. Much of the high response and curative potential of allografts is attributed to a ‘graft-versus-tumor’ effect. In patients with multiple myeloma this effect has been well documented.[3–5] In contrast, stem-cell transplantation from autologous or syngeneic donors provides little or no immunologic effect against the myeloma cell. Thus autologous or syngeneic stem-cell transplants are mainly a form of supportive care and require intensive chemotherapy with or without radiation to accomplish eradication of the disease or alternative strategies designed to duplicate or mimic the graft-versus-myeloma effect. Long-term follow-up of recipients of autologous stem-cell transplants indicate a continuing risk of disease recurrence after 5 years, and arguably few if any patients are cured. In contrast allogeneic stem-cell transplants with long-term follow-up appear to result in durable remissions and a lower risk of recurrence after 5 years."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017399/
Mark
Many factors can effect how well an allo transplant works. A Doctor can estimate an individuals patients chance, but no one number is accurate and applicable to all patients. Here is a general estimate Dr. William Bensinger gave in a 2007 paper.
"Stem-cell transplantation from allogeneic donors may be curative for 10–20% of patients with chemotherapy-resistant, refractory hematologic malignancies, and for up to 80% of patients who are transplanted in remission. Much of the high response and curative potential of allografts is attributed to a ‘graft-versus-tumor’ effect. In patients with multiple myeloma this effect has been well documented.[3–5] In contrast, stem-cell transplantation from autologous or syngeneic donors provides little or no immunologic effect against the myeloma cell. Thus autologous or syngeneic stem-cell transplants are mainly a form of supportive care and require intensive chemotherapy with or without radiation to accomplish eradication of the disease or alternative strategies designed to duplicate or mimic the graft-versus-myeloma effect. Long-term follow-up of recipients of autologous stem-cell transplants indicate a continuing risk of disease recurrence after 5 years, and arguably few if any patients are cured. In contrast allogeneic stem-cell transplants with long-term follow-up appear to result in durable remissions and a lower risk of recurrence after 5 years."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017399/
Mark
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Mark
Re: allo transplant cures?
Hi dee777,
That's not quite what the excerpt says that Mark quoted.
Instead, it says that with allo transplants, patients who stay in remission for five years seem to have a lower chance of relapsing after that point than before making it to the five year mark.
Some allo patients still relapse after five years in remission. Some don't.
But the percentage of allo patients who relapse after five years in remission is lower than the percentage of patients who relapse before they've made it to the five-year mark.
Hope that helps a bit.
(And thanks, Mark, for sharing the quote from the article by Dr. Bensinger.)
That's not quite what the excerpt says that Mark quoted.
Instead, it says that with allo transplants, patients who stay in remission for five years seem to have a lower chance of relapsing after that point than before making it to the five year mark.
Some allo patients still relapse after five years in remission. Some don't.
But the percentage of allo patients who relapse after five years in remission is lower than the percentage of patients who relapse before they've made it to the five-year mark.
Hope that helps a bit.
(And thanks, Mark, for sharing the quote from the article by Dr. Bensinger.)
Re: Allo transplant cures?
I am trying to understand what definition of cure is being used for one. For me cured is no myeloma detected ever again and the person dies at 90 some years of old age. If every one relapses some time, whether 10 years, 20 years, I do not consider that a cure. Prolong life maybe, but not a cure. They never got rid of all their myeloma and it just took longer to get to a point of detection.
Re: Allo transplant cures?
I've always loved Don Wright's definition of a "multiple myeloma cure" and I've adopted much of his philosophy.
"The cure for myeloma," he says, "is to hang on long enough to die of something else. And that is precisely my hope — and my plan, actually."
http://www.npr.org/blogs/health/2013/02/18/172098789/targeted-cancer-drugs-keep-myeloma-patients-up-and-running
"The cure for myeloma," he says, "is to hang on long enough to die of something else. And that is precisely my hope — and my plan, actually."
http://www.npr.org/blogs/health/2013/02/18/172098789/targeted-cancer-drugs-keep-myeloma-patients-up-and-running
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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