Hi there!
The treatment path with stem cell transplantation (SCT) seems pretty straight forward (induction, stem cell collection, SCT, maintenance therapy).
If I chose not to go the SCT route, would it be the same path minus the SCT (induction, stem cell collection for storage, maintenance)? Is the maintenance the same duration?
My doctor said one reason for doing SCT is longer time to relapse. And are there studies showing you can get as deep of a response using novel agents only as you would with SCT? (I am very aware of the ongoing debates!)
Thank you!
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Is the treatment path without SCT the same as with SCT?
Hey Gardengirl,
In a nut, you've pretty much got it right regarding the differences between the two approaches. But don't forget that the high-dose chemo phase that precedes the transplant right after stem cell collection is the real treatment portion of the SCT, and not the transplant itself.
Regarding "time to relapse" (which is PFS), see these two studies.
https://myelomabeacon.org/news/2011/10/31/study-finds-early-and-delayed-stem-cell-transplants-have-comparable-efficacy-in-newly-diagnosed-multiple-myeloma-patients/
https://myelomabeacon.org/news/2013/08/16/stem-cell-transplant-timing-multiple-myeloma/
Saying that the maintenance duration for one treatment approach versus another is longer than another doesn't sound quite right to me, IMHO. Doctors have greatly varied opinions on both their drug selection and treatment duration when it comes to maintenance therapy. So, I personally think it's not accurate to make a blanket statement that one approach would necessarily dictate a longer maintenance duration than another, unless that just happens to be that one doctor's general approach.
I think you might already be aware that there are some important clinical trials that are being done in the USA and Europe to help better answer the above questions regarding whether to transplant or not (or delay) and the role of maintenance.
In a nut, you've pretty much got it right regarding the differences between the two approaches. But don't forget that the high-dose chemo phase that precedes the transplant right after stem cell collection is the real treatment portion of the SCT, and not the transplant itself.
Regarding "time to relapse" (which is PFS), see these two studies.
https://myelomabeacon.org/news/2011/10/31/study-finds-early-and-delayed-stem-cell-transplants-have-comparable-efficacy-in-newly-diagnosed-multiple-myeloma-patients/
https://myelomabeacon.org/news/2013/08/16/stem-cell-transplant-timing-multiple-myeloma/
Saying that the maintenance duration for one treatment approach versus another is longer than another doesn't sound quite right to me, IMHO. Doctors have greatly varied opinions on both their drug selection and treatment duration when it comes to maintenance therapy. So, I personally think it's not accurate to make a blanket statement that one approach would necessarily dictate a longer maintenance duration than another, unless that just happens to be that one doctor's general approach.
I think you might already be aware that there are some important clinical trials that are being done in the USA and Europe to help better answer the above questions regarding whether to transplant or not (or delay) and the role of maintenance.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is the treatment path without SCT the same as with SCT?
Just another perspective ... Some people decide to have a transplant early because you only get one chance to do an early transplant. That was part of my thought process anyway.
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DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
Re: Is the treatment path without SCT the same as with SCT?
Hi GardenGirl,
Although treatment is individualized for each patient, one difference between the SCT vs No SCT treatment paths might be that the patient would receive more cycles in the initial treatment phase for No SCT than the SCT patient receives.
I am in one of the clinical trials comparing these two approaches. I am in the SCT arm of the trial, so I got 3 cycles of VRD for induction, then SCT, then 2 more cycles of VRD for the consolidation phase, then Revlimid maintenance. (I'm currently in the maintenance phase.)
In the No SCT arm, they get 8 cycles of VRD, then the Revlimid maintenance. In both arms, the maintenance phase is 2 years. That's the trial protocol, but of course the treatment can be changed based on how the individual patient is doing.
Hope that helps. Good luck to you!
Mike
Although treatment is individualized for each patient, one difference between the SCT vs No SCT treatment paths might be that the patient would receive more cycles in the initial treatment phase for No SCT than the SCT patient receives.
I am in one of the clinical trials comparing these two approaches. I am in the SCT arm of the trial, so I got 3 cycles of VRD for induction, then SCT, then 2 more cycles of VRD for the consolidation phase, then Revlimid maintenance. (I'm currently in the maintenance phase.)
In the No SCT arm, they get 8 cycles of VRD, then the Revlimid maintenance. In both arms, the maintenance phase is 2 years. That's the trial protocol, but of course the treatment can be changed based on how the individual patient is doing.
Hope that helps. Good luck to you!
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Is the treatment path without SCT the same as with SCT?
Hi Mike,
Interesting to hear that you are in this trial. Your treatment plan with SCT sounds similar to mine. I just finished harvest yesterday and the final treatment will be early December. After that, they will present me with possible trials for follow up. Trials, because there is no decision here on what the standard after SCT is. I guess that the standard was/is not to offer treatment after the SCT.
QUESTION: I was at a conference in Roskilde / Denmark in late September and heard about an international trial with 1500 patients, half of them will get SCT and the other half not. Is it this trial or another one you are participating in?
Best regards
Lev
Interesting to hear that you are in this trial. Your treatment plan with SCT sounds similar to mine. I just finished harvest yesterday and the final treatment will be early December. After that, they will present me with possible trials for follow up. Trials, because there is no decision here on what the standard after SCT is. I guess that the standard was/is not to offer treatment after the SCT.
QUESTION: I was at a conference in Roskilde / Denmark in late September and heard about an international trial with 1500 patients, half of them will get SCT and the other half not. Is it this trial or another one you are participating in?
Best regards
Lev
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: Is the treatment path without SCT the same as with SCT?
Hi Lev and Mike,
I am participating in this trial at Dana Farber in Boston. Patients are picked randomly to have SCT or not, so there is a 50/50 chance of having it. The trial begins at diagnosis before the patient has begun treatment. All patients will have their stem cells harvested. I am in the arm that did not have the SCT. The purpose of this trial is to see if the SCT is necessary. I had the 8 cycles of VRD and then went to Revlimid maintenance.
Mike is this the same trial you are in? Are you in Boston, too?
Debbi
I am participating in this trial at Dana Farber in Boston. Patients are picked randomly to have SCT or not, so there is a 50/50 chance of having it. The trial begins at diagnosis before the patient has begun treatment. All patients will have their stem cells harvested. I am in the arm that did not have the SCT. The purpose of this trial is to see if the SCT is necessary. I had the 8 cycles of VRD and then went to Revlimid maintenance.
Mike is this the same trial you are in? Are you in Boston, too?
Debbi
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DebbiC - Name: Debbi
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 12/23/13
- Age at diagnosis: 53
Re: Is the treatment path without SCT the same as with SCT?
Hi Debbie and Mike,
Do you know if your trials are local ones at your hospitals or a part of one of the international cross-country trials?
Do you know if your trials are local ones at your hospitals or a part of one of the international cross-country trials?
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: Is the treatment path without SCT the same as with SCT?
I'm pretty sure France is involved, but I'm not sure of any other countries.
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DebbiC - Name: Debbi
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 12/23/13
- Age at diagnosis: 53
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