Percentage Of Cancerous Plasma Cells Post Transplant May Predict Outcome In Myeloma Patients
Korean researchers recently found that the percentage of cancerous plasma cells in the bone marrow, measured on day 14 post transplant, may predict disease progression in multiple myeloma patients following high-dose chemotherapy and stem cell transplantation.
However, because their study was small and retrospective in nature, the Korean researchers suggested that further studies be conducted to confirm their findings.
The standard treatment for myeloma patients under the age of 65 years currently consists of high-dose chemotherapy, followed by autologous stem cell transplantation. In this type of transplantation, physicians collect a patient’s stem cells prior to chemotherapy and return these same cells to the individual following treatment.
Although recent advancements have shown that maintenance therapy has improved survival rates after high-dose chemotherapy and transplantation, patients frequently relapse. As a result, researchers are currently investigating the prognostic value of several factors in order to identify what best predicts relapse after transplantation.
In the present study, Korean researchers sought to determine if the percentage of cancerous plasma cells in the marrow at day 14 post transplant could be used as a prognostic factor for outcome.
They retrospectively analyzed data from 39 newly diagnosed myeloma patients who were treated with high-dose chemotherapy and autologous stem cell transplantation between 2003 and 2008. The median patient age at diagnosis was 57 years, and all patients had advanced disease. The median percentage of cancerous plasma cells in the bone marrow was 43 percent at diagnosis.
All of the patients received four 21-day cycles of induction therapy with vincristine (Oncovin), doxorubicin (Adriamycin), and dexamethasone (Decadron). The patients then received preparative therapy with 200 mg/m2 of melphalan (Alkeran) followed by stem cell transplantation. Patients who did not show disease progression following transplantation received two years of maintenance therapy with alpha-interferon and prednisone.
At a median follow-up time of 28 months, the median progression-free survival was 29.1 months, and overall survival was 42.1 months.
The researchers found that the percentage of cancerous plasma cells in the bone marrow on day 14 post transplant strongly predicted disease progression in patients. On day 14 post transplant, the median percentage of plasma cells in the bone marrow was 0.7 percent. Patients with at least 2 percent bone marrow plasma cells had significantly shorter progression-free survival and overall survival than patients with less than 2 percent.
The researchers noted that there was no relation between a patient’s bone marrow plasma cell percentage after induction therapy and the bone marrow plasma cell percentage after transplantation. According to the researchers, this finding indicates that the preparative therapy, and not the induction therapy, impacts the post-transplant bone marrow plasma cell percentage.
The researchers suggested that the post-transplant bone marrow plasma cell percentage represents a strong predictive factor for disease progression, regardless of a patient’s disease status prior to transplantation.
For more information, please refer to the study in the Korean Journal of Internal Medicine (abstract).
Related Articles:
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- Early Use Of Radiation Therapy Associated With Shorter Survival In Multiple Myeloma
- Selective Digestive Decontamination May Reduce Risk of Infection In Myeloma Patients Undergoing Autologous Stem Cell Transplants
- Revlimid, Velcade, and Dexamethasone, Followed By Stem Cell Transplantation, Yields Deep Responses And Considerable Overall Survival In Newly Diagnosed Multiple Myeloma
- Sustained Complete Response To Initial Treatment Associated With Substantial Survival Benefit In Multiple Myeloma
OK, so if I understand the results of this study correctly it means, that AT ANY TIME when you have less than 2% of cancerous plasma cells...that is the OPTIMUM time for SCT?
So, the goal is to have that 2% level PRIOR to induction therapy for SCT?
Is that the right interpretation?
IOW's it is not just having a relapse that should determine going for the SCT, but rather, if you approach 2% of cancerous plasma cells, you should go on a regimen drive that level down to 2% at the first sign of relapse and THEN do the SCT?
If so, is it even essential to go through the highly toxic induction therapy?
Should conventional therapy be changed from at first relapse get SCT to at first relapse, drive those cancer cells down and then do SCT and forego induction?
Just curious.
What are clinicians seeing...is this the first study making this significant correlation?
Is the population to small to make it a standard of care?
Hi suzierose,
The average percentage of cancerous plasma cells at diagnosis (prior to induction therapy) was 43 percent. Very few, if any of the study participants had less than 2 percent cancerous cells prior to induction.
The researchers found that there was not a correlation between the percent of cancerous plasma cells after induction and after stem cell transplantation. In other words, having less than 2 percent cancer cells after induction did not necessarily mean better survival.
The key was having less than 2 percent cancerous cells after stem cell transplantation.
That said, the current belief is that it is better to reduce the number of cancerous cells before high-dose chemotherapy and stem cell transplantation. Some physicians will treat extensively to try to achieve a complete response prior to transplantation; others will treat with several rounds of induction therapy and proceed to transplantation if the patient achieves a good response, even if it isn't a complete response.
If a patient undergoes transplantation at relapse, the physician will always treat with some form of induction therapy to reduce the number of cancerous cells before the patient is treated with high-dose chemotherapy and receives the transplant. This small, retrospective study certainly would not be sufficient to convince physicians to proceed directly to high-dose chemotherapy and transplantation at relapse without first treating with induction therapy.
Here is the excerpt I focused on:
"Patients with at least 2 percent bone marrow plasma cells had significantly shorter progression-free survival and overall survival than patients with less than 2 percent....
The researchers suggested that the post-transplant bone marrow plasma cell percentage represents a strong predictive factor for disease progression, regardless of a patient’s disease status prior to transplantation..... According to the researchers, this finding indicates that the preparative therapy, and not the induction therapy, impacts the post-transplant bone marrow plasma cell percentage."
What is meant by peparative therapy vs. induction therapy?
I interpreted it as chemo prior to SCT is inductive and chemo cycles before induction are preparative, is that incorrect?
And the concluding sentence seems to indicate that it is NOT induction therapy but prepartive therapy that determines if there will be 2% post SCT. Am I interpreting this incorrectly?
IOW's what determines whether you have less than 2% post SCT cancerous plasma cells, based on this article?
Hi suzierose,
Induction therapy is the initial therapy. It often is a combination therapy and often includes one or more novel agents.
Preparative therapy is the high-dose chemotherapy (typically melphalan) used to wipe out the bone marrow just before stem cell transplantation.
So a patient is treated with induction therapy, then preparative therapy (i.e. high-dose chemotherapy), and then undergoes the stem cell transplant.
Therefore, this study found that response to induction (initial) therapy used to initially reduce the number of cancer cells did not directly impact the percentage of post-stem cell transplant cancerous cells. Instead, the high-dose chemotherapy used just before stem cell transplantation had a direct impact on the percentage of cancer cells post-transplant.
Ahhhhh!!
Thank you, I have the preparative and induction switched..
I appreciate your help.
Got it!!
Thanks!!
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