Wednesday, November 24, 2010

Tandem transplants proven to create longer life expectancy!!!!

In this study from the Myeloma Beacon, "long-term follow-up results indicate double transplantation is superior to single transplantation for Myeloma."

Some highlights:

* Significantly better 10-year overall and event free survival

* 12 percent of patients still in remission at a median follow-up time of 13.6 years

* Study shows that after 11 years, rates of recurrence were much less likely to relapse later

* Study included alkalyting agents (nasty chemo) but no novel agents (thalidomid, revlimid, velcade)

ALL of this supports BB, UAMS, and Total Therapy.  BB refuses to put his patients into a blind trial because he thinks it would be unethical not to use the regimen he feels has the best chance of saving their life in order to prove a point.  To my knowledge, this is the first published data of such a trial, and the first document outside of Arkansas that supports the tandem transplant concept.

That makes this extroardinarily important.

EVERYTHING BB was doing when I was diagnosed -- Relvimid in newly diagnosed patients, Velcade in newly diagnosed patients, maintenance therapy -- has subsequently been accepted by the establishment who at the time of my diagnosis said BB was crazy to do it.  I've written here that tandem transplants would be the last domino to fall.  But now, this data proves him to be right about that as well.

I don't normally directly proselytize beyond telling my own story, and to be clear there are some for whom Total Therapy is not the right choice, and there are about 20% of patients who don't respond to any treatment.  

But I **URGE** anybody newly diagnosed with this disease to explore the aggressive option.  It may just save your life.  There is a lot of literature and blogosphere commentary about being conservative -- I am one loud voice to the contrary.  Explore your options -- and before considering something like JB's protocol, ask him how many of his patients are still alive after 10 years of treatment.  Better still, ask ANY doctor with whom you are talking.

BB will tell the exact many people are alive after any given number of years.  Beware any doctor that won't share that information, or sees too few Myeloma patients to keep track of it.

Okay, that's enough.  What GREAT news for all of us, though!!!!!   :)

Full text of the article copied below.

Long-Term Follow-Up Results Indicate Double Transplantation Is Superior To Single Transplantation For Myeloma

4 CommentsBy Jessica Langholtz and Julie Shilane
Published: Nov 23, 2010 5:52 pm
Long-Term Follow-Up Results Indicate Double Transplantation Is Superior To Single Transplantation For Myeloma
Long-term follow-up results from a clinical trial show that multiple myeloma patients who underwent two stem cell transplants remained in remission longer and also survived longer than patients who underwent one transplant. These findings are updated results from a previously published study comparing single versus double transplantation.
Multiple myeloma patients are commonly treated with stem cell transplantation. Several studies have shown a survival benefit to having a second transplant a couple of months after the first. However long-term follow-up results are necessary to confirm this.
Patients were recruited for the study between 1992 and 1997, and the initial findings were published in 2001. The current report includes updated results of the trial after following the patients for a median of 13.6 years.
The clinical trial evaluated the outcome of 90 patients (46 newly diagnosed and 44 pre-treated) who were planning on undergoing double (also known as tandem) stem cell transplantation using their own stem cells.
Of the 90 patients, 49 patients actually underwent the second transplantation.
Stem cells for the first transplant were collected prior to a preparative conditioning regimen of high-dosemelphalan (Alkeran) and then transplanted back after the melphalan treatment.
Stem cells for a second transplant are often collected at the same time as the stem cells for the first transplant, but some myeloma cells remain in the bone marrow and can be collected along with the stem cells. In an attempt to increase the efficacy of the regimen, this study collected stem cells for the second transplant several months after the first transplant.
Patients who were eligible for the second transplant received conditioning therapy with a combination of busulfan and cyclophosphamide (Cytoxan) and then received transplanted cells that were collected after their first transplant.
At the time of the trial, novel agents, such as thalidomide (Thalomid), Revlimid (lenalidomide), and Velcade(bortezomib), had not yet been introduced for the treatment of myeloma.
In both the original and updated reports, patients undergoing tandem transplantation experienced a median overall survival of 84 months. However, long-term follow-up showed that overall survival of patients who underwent single transplantation decreased from 49 months in the initial analysis to 44 months in the updated report.
Initially, the data showed that patients receiving tandem transplants were likely to have better survival than patients receiving a single transplant. However, only in the follow-up results was the difference between the two groups significant, demonstrating the importance of long-term follow-up of clinical trial participants.
Patients who received tandem transplants also achieved significantly better 10-year overall and event-free survival than patients who received a single transplant (34 percent versus 18 percent for overall survival, and 18 percent versus 0 percent for event-free survival). This data was similar to previous studies comparing single and double transplants.
The researchers noted that at the time of the follow-up analysis, 12 percent of patients who underwent tandem transplantation were still in remission. They also noted a “plateau” in remission rates after 130 months (almost 11 years), meaning that patients who were still in remission at that time were much less likely to relapse later. They attributed this long-term remission to the high-intensity of the regimen, not the use of stem cells collected after the first transplant.
The researchers concluded that the new long-term follow-up data confirm the promising results published in the original report. Additionally, the long-term results show that tandem transplantation is superior to single transplantation.
In their evaluation of the updated follow-up data, the researchers cautioned that it is important to consider a possible selection bias in the trial. Patients with a good prognosis may have been more likely to undergo a second transplant. The primary reasons for not undergoing the second transplant were insufficient stem cell harvest (23 percent, likely due to harvesting after high-dose melphalan), toxicity of previous treatment (9 percent), and progressive disease (8 percent).
For more information, please read the follow-up report in the Journal of Clinical Oncology (pdf) or the initial results published in Bone Marrow Transplantation.

Thanksgiving and a Forgotten Anniversary

Thursday, November 13, 2008.  This was the date that I was diagnosed with Multiple Myeloma, and told that median life expectancy was five years.

It's a date that one might thing I would not let pass unnoticed.  I knew that it was sometime in November, but I didn't recall the exact date.  And I was going to make a blog post about it, but didn't get around to it -- been working too much lately.

At any rate, it came and went.  I don't live my life as though I have Myeloma.  I take pills at night, they have some side effects that I'll be glad to be rid of eventually.  I get Velcade once a week -- I've grown to view these visits as respites from the frantic pace of my job.  I go to Arkansas once every four months now, for a series of tests which generally bore me to tears, and at which I now fully expect to see no return of the cancer.  And I wait, patiently but with growing confidence and conviction, that in two years time I will be off meds and will be told, definitively, by the doctor who sees more Myeloma than anybody in the world that it will not be coming back.

And so...I give Thanks tomorrow to the doctor who saved my life,  my family and friends that make it worth saving, and everybody in the Myeloma community -- doctors, nurses, patients, caregivers and the precious followers of this blog who sustained me at my lowest and still inspire me with their own stories and their care for mine.

Warm wishes to all of you for this holiday.