Hi everyone,
My husband was diagnosed with multiple myeloma in August. After 3 cycles of VCD then 1 cycle of VCRD, his M-Spike is down from 6.8 to 0.31. He has done stem cell collection and we are doing SCT after the holidays. My question is.. Do we have to do SCT if he's had a good response to treatment right now? or could we just continue with treatment and hope his numbers will continue to go down?
Any comments will be helpful.
Thanks and have a blesed healthy holidays!
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Re: Should we proceed to SCT or keep doing therapy???
It sounds like everything is going according to plan with your husbands treatment and you have acheived a VGPR (Very Good Partial Response [>90% reduction]). There are opitons at this point. 1) Procede direct to high dose melphalan (HDM) and ASCT (transplant); 2) Harvest your stem cells, store them, and continue on a maintenance type dosing (likely Rev 10-15mg daily)/or observe until relapse, treat at relapse, then do transplant; and 3) maintenance without transplant.
Your response is excellent and years ago- before Revlimid and Velcade- these responses were nearly impossible with traditional agents alone. Therefore, HDM-ASCT was used to improve responses and in turn survival. We initally hoped that the novel agents (Rev and Vel) with the excellent responses observed would obviate the need for HDM-ASCT. However, although the data is not mature, it is generally appreciated that HDM-ASCT remains important in sequence with therapies as you have received to maximize overall survival. This may not be true for everyone, but we are not yet smart enough to know who those individuals are today. So, I believe that if you are a candidate and it is not too-high risk, HDM-ASCT should be part of everyone's therapy.
To do it now vs after relapse (1 vs. 2)? The data that exists states that either affords the same survival advantage. To this end, there is no "wrong answer." I tend to recommend to all my patients to receive HDM-ASCT upfront and not wait. But YOU as the patient and care-givers get to participate in these descisions.
In your case, I am not sure of the treatment course or how your husband tolerated therapy, or the rationale for the addition of a 4th drug to your regimen (VCRD vs VCD). If it was do to a marginal response to 3 drugs alone, I would consider getting HDM-ASCT upfront and not waiting for relapse. You have acheived a VGPR with therapy to date, I would try and get the most out of that response. Because there is always chance that after relaspe you may not respond to the same degree.
-But again this desicion remains up to you, your husband and your oncologists.
Merry Christmas and Happy New Year
Your response is excellent and years ago- before Revlimid and Velcade- these responses were nearly impossible with traditional agents alone. Therefore, HDM-ASCT was used to improve responses and in turn survival. We initally hoped that the novel agents (Rev and Vel) with the excellent responses observed would obviate the need for HDM-ASCT. However, although the data is not mature, it is generally appreciated that HDM-ASCT remains important in sequence with therapies as you have received to maximize overall survival. This may not be true for everyone, but we are not yet smart enough to know who those individuals are today. So, I believe that if you are a candidate and it is not too-high risk, HDM-ASCT should be part of everyone's therapy.
To do it now vs after relapse (1 vs. 2)? The data that exists states that either affords the same survival advantage. To this end, there is no "wrong answer." I tend to recommend to all my patients to receive HDM-ASCT upfront and not wait. But YOU as the patient and care-givers get to participate in these descisions.
In your case, I am not sure of the treatment course or how your husband tolerated therapy, or the rationale for the addition of a 4th drug to your regimen (VCRD vs VCD). If it was do to a marginal response to 3 drugs alone, I would consider getting HDM-ASCT upfront and not waiting for relapse. You have acheived a VGPR with therapy to date, I would try and get the most out of that response. Because there is always chance that after relaspe you may not respond to the same degree.
-But again this desicion remains up to you, your husband and your oncologists.
Merry Christmas and Happy New Year
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Should we proceed to SCT or keep doing therapy???
Hi Dr. Shain,
Thank you for your response. I hope you had a wonderful holiday.
This is certainly very helpful.
We had to add the Rev after the VCD cycles because his numbers didn't go down as much after the third one. But once he got the Rev, it went down until we got 0.31 on his last test.
He had very minimal neuropathy with Velcade and in general tolerated the therapies well.
Do we have data today about how patients tolerate and respond to treatments after HDM-ASCT compared to how they responded to treatments prior?
Does ASCT mess up the body such that treatments are 'tougher' on the patient post ASCT?
Any insight will help.
Thank you for your response. I hope you had a wonderful holiday.
This is certainly very helpful.
We had to add the Rev after the VCD cycles because his numbers didn't go down as much after the third one. But once he got the Rev, it went down until we got 0.31 on his last test.
He had very minimal neuropathy with Velcade and in general tolerated the therapies well.
Do we have data today about how patients tolerate and respond to treatments after HDM-ASCT compared to how they responded to treatments prior?
Does ASCT mess up the body such that treatments are 'tougher' on the patient post ASCT?
Any insight will help.
3 posts
• Page 1 of 1