A group of researchers in India published a study ^[1] recently that had me jump to two conclusions.

Their research followed 170 autologous stem cell transplant patients over the years, starting around 1990, to see how these multiple myeloma patients fared.

There is, of course, good news and bad news.

The first takeway seems to be that you can make a case that things are getting better.

The research adds to the body of knowledge indicating that novel agents are leading to better response rates and increased overall survival for those who go the transplant route.

The second takeaway, unfortunately, isn’t quite so positive.

The idea behind the study was to determine prognostic characteristics of those with myeloma to determine what factors lead to better transplant responses.

The research identified a bunch of things that lead to a better response.

These predictive factors include: albumin levels in the blood of at least 3.4 g/dL at diagnosis; responding to the transplant – in particular, achieving a complete response; and receiving treatment with novel agents.

The kicker is, for those who don’t fit the neat little box of positive factors, the survival prospects can get a little, well, grim.

As Charles Dickens wrote, “It was the best of times, it was the worst of times.”

Of course, this has been the case with myeloma for a long time.

Some people respond to treatment.  Others don’t respond so much.

Clearly, though, this study reaffirms the perception that myeloma doctors have had for some time – that achieving a complete response is extremely important.

In the study, the researchers wrote:  “Achievement of CR [complete response] is an important event in myeloma and represents the major surrogate marker for long-term OS [overall survival] and EFS [event-free survival].”

The overall survival chart ^[2] for the study is pretty clear on this.

The complete response line lazily stretches across the chart for month after month, year after year, with a slow decline.

For other responses, it’s kind of like falling off a cliff.  The lines for the other response categories have rapid declines.

Because some of these transplant cases go back two decades, the researchers analyzed the results of those treated before and those treated after the introduction of novel agents.  The study tends to confirm what the researchers referred to as the “superiority of novel agent-based induction therapy;” the response rates after autologous stem cell transplant were higher for those treated after the introduction of novel agents.

The research also showed that before novel agents, responses to autologous transplant were better if the procedure was done within 12 months of diagnosis.  But, since the introduction of novel agents, that difference “is no longer present.”

It’s encouraging that transplantation no longer needs to be the first and main line of defense – perhaps you can save it for later, as many have been doing lately.

So what’s the point here?

There are many of us who fit into a box of characteristics and factors that work together to help new treatments and transplantation give us increasingly better responses.  Under the optimum conditions, you can live quite a long time.  There are people in this study who achieved a complete response and are now pushing 18 years of survival.

But there are also a significant number of other myeloma patients who don’t fit into that box.

Unfortunately, there doesn’t seem to be a whole lot that can be done for them.

And they fall off the cliff.