Published on October 20, 2020
Autologous Stem Cell Transplants After Relapsed Multiple Myeloma
Should a multiple myeloma patient harvest their stem cells in case they need a transplant later on or after a relapse? What factors should be considered when looking at an autologous stem cell transplant as a treatment option after a relapse? If a patient has already had a transplant and now has relapsed, can they get a second transplant?
During our recent Answers Now program, multiple myeloma patients and stem cell transplant survivors Jack Aiello and Steve Albano spoke with Dr. Amrita Krishnan from City of Hope to discuss these questions. Dr. Krishnan also shares the important questions you need to ask your doctor, and clinical data to back up a patient's decision when considering a second stem cell transplant.
This is Part 2 of a 3-part series. Watch all segments in the series below:
Transcript | Is Stem Cell Transplant Best for Relapsed Myeloma Patients?
Should Myeloma Patients Harvest Stem Cells During Early Treatment?
Transplants might also be an option after a patient’s first or subsequent lines of treatments when a relapse is determined. So let's learn a little bit more about when that might be also a preferred option. I guess, first of all, do you recommend that patients harvest their stem cells at least during the early treatment line?
Certainly, if patients choose that they don't want to have a transplant as part of their initial therapy, because some of the drugs such as lenalidomide (Revlimid) given over a long period of time, make it more difficult to collect stem cells. So if their insurance company allows that, then certainly that is part of our treatment discussion.
What Factors Should Patients Consider for Stem Cell Transplants After Relapse?
And if a patient didn't have an initial transplant, but has relapsed, what factors should they, do you consider for getting a delayed, let's call it, transplant?
Some of it again depends on their physiologic status in terms of how well are they. The issue is, if you don't do a transplant in the beginning and you wait until it relapses, you are going to need more treatment basically, because you try to first give initial more chemotherapy to try and reduce the amount of myeloma if there’s a lot. Sometimes fortunately people don't relapse with a big amount of myeloma, but that's the first question. Do they need more treatment first before going to the transplant? Or can you go straight into the transplant, is really those kinds of discussions that we're having.
Can Patients Who Had an Initial Transplant Have a Second Transplant in Relapse?
So a related question. So what about patients who did have an initial transplant and are relapsing? Can they have a second transplant and what factors go into that decision?
So there was a trial in Britain, which actually looked at people getting a second transplant and compared them to the option of getting just more chemo. And getting that second transplant actually was associated with a longer survival compared to the patients who got just more chemo. A lot of that has to do with timing. So for how long your first response to the transplant lasts. Generally, we use about 18 months as the cutoff. So if patients relapse less than 18 months after their first transplant, we don't think they're going to get a significant benefit from doing a second transplant. But we have patients who after four or five, six years after their first transplant, relapse, and given that they’ve had such a great response to the first time, certainly those are the types of patients where we think about doing a second transplant. I'd say in the United States, we do quite a few now, about anywhere between 500 to, I think the number's up to 800 patients a year getting those second transplants.
Are There New Developments in Relapsed Myeloma Stem Cell Transplants?
Is that evolving at all, given all the new drug approvals?
Jack's part of the SWOG Myeloma Committee. So he knows that there have been proposals through that committee, looking at that second transplant to say, "Do we make it more intense? Do we add more chemo? Do we do something after it?" So certainly there's a lot of interest in how to make that second transplant different than the first one, both in terms of the chemo part of the transplant, as well as the maintenance part.
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