I was diagnosed in March and have been through 4 cycles of Kyprolis, Revlimid, and dexamethasone (KRd) plus Darzalex (daratumumab) in a clinical trial, with excellent response. Paraprotein is down from 3.25 to 0.07 g/dL (32.5 to 0.7 g/L) and kappa-lambda ratio is in the normal range. Doctor classifies me as having a very good partial response (VGPR).
I now face the decision of going to transplant or staying in the clinical trial for four more cycles. I am having stem cells harvested next week (August 11) and am penciled in for transplant in early September.
From the research I have done, I am leaning to the transplant, but, would welcome advice and opinions from those that have "been there and done that".
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Re: Do transplant, or continue with KRd plus Darzalex?
Hello Ts:
Can you go a couple of more cycles before you decide? Since you are on clinical trial, maybe that would not be allowed. I will shrink from making a firm recommendation, but I think you do want to get to a complete response (CR) or minimal residual disease (MRD) negative. Your response so far is impressive, but not there yet. How have you tolerated the 4 drug regimen so far?
I would say that getting a couple of more rounds in would be good. If the additional rounds got you to MRD negative, that would be a good thing, and you would be in a better position to defer a stem cell transplant until after first relapse. If you did not get to MRD negative with a couple of more rounds, then I would lean towards a stem cell transplant in that case.
However, I am guessing from your clinical trial that now is your decision point, which would make it a bit more of tough decision. If I have guessed right, then your decision would be which do you think would have a better chance of wiping out the remainder of disease.
It is impossible to predict for certain, however, I think that the four more rounds of KRD-Darzalex is not as tried as an autologous stem cell transplant, but probably as good. Of course there is no data on this, and I am guessing that purpose of your clinical trial is to answer that question.
Good luck to you.
Can you go a couple of more cycles before you decide? Since you are on clinical trial, maybe that would not be allowed. I will shrink from making a firm recommendation, but I think you do want to get to a complete response (CR) or minimal residual disease (MRD) negative. Your response so far is impressive, but not there yet. How have you tolerated the 4 drug regimen so far?
I would say that getting a couple of more rounds in would be good. If the additional rounds got you to MRD negative, that would be a good thing, and you would be in a better position to defer a stem cell transplant until after first relapse. If you did not get to MRD negative with a couple of more rounds, then I would lean towards a stem cell transplant in that case.
However, I am guessing from your clinical trial that now is your decision point, which would make it a bit more of tough decision. If I have guessed right, then your decision would be which do you think would have a better chance of wiping out the remainder of disease.
It is impossible to predict for certain, however, I think that the four more rounds of KRD-Darzalex is not as tried as an autologous stem cell transplant, but probably as good. Of course there is no data on this, and I am guessing that purpose of your clinical trial is to answer that question.
Good luck to you.
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JPC - Name: JPC
Re: Do transplant, or continue with KRd plus Darzalex?
Hi Tswms54,
I did 2 transplants back in 2011 (1 auto and 1 allo). I am currently in a myeloma drug-free remission and enjoy an excellent quality of life. Given that you had the opportunity to use Darzalex as part of your upfront therapy, you may have the opportunity to enjoy a long-term drug-free remission without doing an allo if you do the auto transplant and gain the proven benefit of high dose melphalan.
In my opinion it depends on what you put more value on – the short term or the long term. In the short term, the transplant is the more difficult path. For me, the short-term inconvenience of the transplants has been compensated by the long-term drug free remission period. Other patients seem to put more emphasis on the short term, so the no-transplant path makes sense for them
Best of luck with your decision! There is not a right or wrong one, nor is there any trial with long-term followup with your induction therapy.
Mark11
I did 2 transplants back in 2011 (1 auto and 1 allo). I am currently in a myeloma drug-free remission and enjoy an excellent quality of life. Given that you had the opportunity to use Darzalex as part of your upfront therapy, you may have the opportunity to enjoy a long-term drug-free remission without doing an allo if you do the auto transplant and gain the proven benefit of high dose melphalan.
In my opinion it depends on what you put more value on – the short term or the long term. In the short term, the transplant is the more difficult path. For me, the short-term inconvenience of the transplants has been compensated by the long-term drug free remission period. Other patients seem to put more emphasis on the short term, so the no-transplant path makes sense for them
Best of luck with your decision! There is not a right or wrong one, nor is there any trial with long-term followup with your induction therapy.
Mark11
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Mark11
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