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Is it best to have a stem cell transplant done upfront?
I have read that if one is newly diagnosed that perhaps it is better to have the stem cell transplant done immediately. Does this make sense?
Re: Is it best to have a stem cell transplant done upfront?
This is a subject which has been discussed a lot on this forum Mildred.
The bottom line is that there has been no definitive apples-to-apples clinical trial data that is based on a large sample of patients using the currently available drug therapies and consistent maintenance strategies to help answer this question. Answering the questions of whether early transplant will improve both progression-free-survival and overall survival outcomes is the purpose of some major clinical trials that are currently underway ... and folks on this forum that are considering auto transplants are hoping to have some preliminary data from these trials later in 2015.
And, of course, each patient and their particular circumstances (cytogenetics, risk, age, overall health, etc) needs to be considered and discussed with your doc when making the decision to do an auto or allo transplant, delay transplant until relapse or forego a transplant altogether in favor of a drug-only treatment approach.
You might find this recent debate to be insightful:
"Anderson & Giralt debate about early vs. late SCTs," Beacon forum discussion started Oct 8, 2014.
The bottom line is that there has been no definitive apples-to-apples clinical trial data that is based on a large sample of patients using the currently available drug therapies and consistent maintenance strategies to help answer this question. Answering the questions of whether early transplant will improve both progression-free-survival and overall survival outcomes is the purpose of some major clinical trials that are currently underway ... and folks on this forum that are considering auto transplants are hoping to have some preliminary data from these trials later in 2015.
And, of course, each patient and their particular circumstances (cytogenetics, risk, age, overall health, etc) needs to be considered and discussed with your doc when making the decision to do an auto or allo transplant, delay transplant until relapse or forego a transplant altogether in favor of a drug-only treatment approach.
You might find this recent debate to be insightful:
"Anderson & Giralt debate about early vs. late SCTs," Beacon forum discussion started Oct 8, 2014.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is it best to have a stem cell transplant done upfront?
The debate that Multibilly is referring to is probably the best indicator of the uncertain "state of the art" that we have to live with just now.
I know that a large international trial is being performed now. 1.500 patients is included. All those participating are regarded as ready for ASCT. Half of them will get ASCT and the other half will not.
Stem cells will be harvested from all who are participating, so that they can still get ASCT if they should need to at a later stage.
We will probably have to wait some years before the final results are known. And, at the moment, our physicians and we will have to make the decision without knowing the right answer.
The myeloma physicians in Denmark (and many other places) are open to changes, but, at the moment and before evidence is available, the general advice seem to be to go for ASCT for all who are strong enough to go through the procedure.
Greetings
I know that a large international trial is being performed now. 1.500 patients is included. All those participating are regarded as ready for ASCT. Half of them will get ASCT and the other half will not.
Stem cells will be harvested from all who are participating, so that they can still get ASCT if they should need to at a later stage.
We will probably have to wait some years before the final results are known. And, at the moment, our physicians and we will have to make the decision without knowing the right answer.
The myeloma physicians in Denmark (and many other places) are open to changes, but, at the moment and before evidence is available, the general advice seem to be to go for ASCT for all who are strong enough to go through the procedure.
Greetings
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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 it best to have a stem cell transplant done upfront?
There is great debate. Our daughter had her SCT 7 months after diagnoses. She was 33 at the time and in complete remission from induction therapy. After transplant she was still in CR. She did maintenance therapy with Revlimid. She relapsed 18 months after her SCT.
She is 35 now and doing carfilzomib [Kyprolis] and dex. I know they are probably going to say do another transplant. They have even mentioned an allo. I feel like the first one didn't really help. She was in remission before it. With all the meds now, I think doing them gives her more time till transplants are perfected and show more success.
Each person is different, though, and each person's myeloma is different. Also how long can you stay on these different chemos? They are all toxic. Who knows what the right answer is?
She is 35 now and doing carfilzomib [Kyprolis] and dex. I know they are probably going to say do another transplant. They have even mentioned an allo. I feel like the first one didn't really help. She was in remission before it. With all the meds now, I think doing them gives her more time till transplants are perfected and show more success.
Each person is different, though, and each person's myeloma is different. Also how long can you stay on these different chemos? They are all toxic. Who knows what the right answer is?
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