[Anonymous]

Total Therapy 3 for a pretreated patient?

by Anonymous on Mon Feb 04, 2013 8:17 pm

Good evening everybody. It's my first time posting. My name is Susan. I had 3 cycles of chemotherapy and i went into a complete remission. I am out of treatment already 4 months and there are no signs of the disease. I was discussing with my doctor the possibility of performing a protocol with the name Total Therapy 3 . The main problem is that, this protocol has been validated for non pretreated newly diagnosed patients. I am skeptical about which is the chance of failure on this protocol when i am pre-treated? Is there a possibility that the protocol will not be effective for a patient that had pretreatment or a long time out of treatment? Thank you and wish you a good luck in our journey.

[TerryH]

Re: Total Therapy 3 for a pretreated patient?

by TerryH on Mon Feb 04, 2013 9:02 pm

Hi Susan,

Welcome to the forum.

Can you give us a bit more background about your initial therapy? Specifically, what was the treatment regimen that you received for 3 cycles?

Also, from your posting, it seems that you didn't receive a stem cell transplant after your initial therapy. Is that correct?

[Ron Harvot]

Re: Total Therapy 3 for a pretreated patient?

by Ron Harvot on Mon Feb 04, 2013 11:33 pm

TT3 is performed an the University of Arkansas and is a deriviative of the double Auto SCT. It is considered leading edge for ASCT technology. It is a very aggressive therapy aimed at a potential cure and/or long term remission. I use the term potential as multiple myeloma is not currently a curable form of cancer. As with any choice in treatment there are benefits and down sides. A douple ASCT in essence destoys the bone marrow not once but twice and after the second round is regrown with hopefully disease free marrow. There is an extended period of hospital stay and extended period of time when your body has to regrow its immune system.

Here is a link that may help you understand more.

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=36161

Ron

[Anonymous]

Re: Total Therapy 3 for a pretreated patient?

by Anonymous on Tue Feb 05, 2013 6:04 am

I received 3 cycles of VRD-PACE and then i went out f treatment for 4 months in order to wait and see how the myeloma behaves. I collected 10 million stem cells for the transplant. But after these results my doctor believes that if we would follow a more agressive approach as it is the TT3, i would have the chance for a very long term remission. The problem is that, we don't know how this protocol works with already pretreated patients. Susan

[jk60]

Re: Total Therapy 3 for a pretreated patient?

by jk60 on Tue Feb 05, 2013 10:06 am

You might want to contact Arkansas and discuss this with them.

[TerryH]

Re: Total Therapy 3 for a pretreated patient?

by TerryH on Tue Feb 05, 2013 11:24 am

Thanks, Susan, for the additional information about your prior treatment.

I'm guessing what your doctor is thinking of doing is a variation of the Total Therapy 3 regimen which will substitute Revlimid for the thalidomide usually used in TT3. I'm not sure I'd recommend switching completely to TT3 at this point given that you've just been treated with VRD-PACE, which is very similar to the VDT-PACE used in TT3. Why not save thalidomide for use later, especially if you're responding well with the Revlimid in VRD-PACE.

Ron is right that TT3 was developed and it and variations of it the main kind of treatment at UAMS, which is also the main center using the approach.

But there are other centers out there which also are using the approach. Many of them are headed by physicians who used to be at UAMS. For example, Dr. Guido Tricot at the University of Iowa and Dr. Elias Anaissie at the University of Cincinnati. I believe from what he has said here in the forum that even Dr. Jayesh Mehta at Northwestern, who can be critical of UAMS at times, implements aspects of the UAMS approach in his practice.

As Ron said, TT3 is an aggressive, very intense approach to treating myeloma. It involves multiple agents in the induction regimen (the VDT-PACE regimen), two transplants, and consolidation and maintenance therapy after each transplant.

It's the polar opposite of the approach recommended by, for example, Dr. Berenson on the west coast, who avoids transplants if at all possible, and also differs significantly from the "adaptive therapy" approach advocated by most myeloma specialists at Mayo.

For videos of a debate between Dr. Barlogie (UAMS) and Dr. Rajkumar (Mayo) about the pros and cons of the TT approach, see this forum thread and the links in it:

https://myelomabeacon.org/forum/barlogie-rajkumar-is-myeloma-curable-debate-t791.html

[Anonymous]

Re: Total Therapy 3 for a pretreated patient?

by Anonymous on Tue Feb 05, 2013 11:39 am

Thank you so much. I actually went to uams in order to seek their advice but as i understood they tried to avoid to advise me. Their only advise was that i should continue the treatment in their facility. Thanks and regards. Susan

[GaryP]

Re: Total Therapy 3 for a pretreated patient?

by GaryP on Tue Feb 05, 2013 6:20 pm

Hi Susan, I was originally treated in Feb. at Mayo in Jacksonville. My original treatment included CTD, or Cytoxan, Thalidomide, and High dose dex. Then Td as ongoing treatment. I then decided to have the rest of my treatment as a modified TT3 program at UAMS and started in May( modified because of kidney failure). It included TD-ACE induction, two transplants with VTD-ACE and fractional dosing of melphalan, consolidation with VTD-ACE and then 4 years of VTd maintenance. I was low risk, and have been in CR for 7 years or since my treatments at Mayo. I often wondered why this protocol was not duplicated in other locations other than those that are UAMS graduates like University of Cincinnati, University of Iowa, Hackensack, et al. I would argue that it makes sense to be treated at a facility that does a lot of SCT's. A year ago I was taken off all drugs and my doctor at UAMS told me that the myeloma would not be comming back. So Susan, it has worked for me so far, and I hope that it works well for you as well. Best Regards/Gary Petersen

[Anonymous]

Re: Total Therapy 3 for a pretreated patient?

by Anonymous on Wed Feb 06, 2013 7:30 am

Thank you for the information Gary. I am really happy to hear about your success. I will try also to make a similiar protocol with the Total Therapy 3 . My first treatment was done in May 2012 . I had a chemo on May, on July and one on November. I am afraid that i am undertreated that why i will start now the TT3 protocol in order to try to produce long term efficiency. Thank you

[truefiction]

Re: Total Therapy 3 for a pretreated patient?

by truefiction on Fri May 17, 2013 10:02 am

I would like to point out that though Tricot spent time in Ark, his schema is not identical to TT3. One major difference is the second transplant. Tricot has added BCNU for the 15% of pateints who develop melphalan resistant cells. In addition, he has added GEMZAR for its ability to disrupt DNA cell repair. He also only follows a 1 - 2 year maintenance schedule. Induction is one round of VTD-PACE and consolidation....for those who responded to the induction....is one round of VTD-PACE.