Can Myeloma Patients Stop Treatment After Transplant?

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Jack Aiello:

We have a question from a caller named Mona who is a myeloma patient and did an allotransplant. Kristen, I'm going to ask you this question.  She did an allotransplant in 2012.  She's been on lenalidomide (Revlimid) maintenance now for six years, and she's a university instructor and leads a very active working life.  Her question, though, has to do with does she take—and this will be actually for all of you—do I take—in fact, let me ask this of Dr. Krishnan.  Do I take Revlimid, continue to take Revlimid indefinitely, or is there a time when I can actually stop taking it?  

Dr. Krishnan:

So the allo setting is a little bit different and because we really have no large trials.  The only trial we have using—two trials using Revlimid after allotransplant, one in the U.S., one in Europe, it was actually quite a challenge.  A lot of patients developed graft-versus-host disease, so really only a minority of patients were able to tolerate it, and to say on it for as long as she has is actually quite impressive.  So, honestly, in her case we don't have any clear recommendation.  

In the autologous setting we have differences right now.  We do have…

Jack Aiello:

…I misspoke.  Hers was an autologous transplant.  I'm sorry.  

Dr. Krishnan:

Okay.  In the autologous setting we have the U.S. approach which was based on the CALGB CTN trial, which randomized patients after transplants or observation or to lenalidomide indefinitely unless they developed toxicity or the myeloma progressed.  

The French had a trial that actually started out with the same idea, indefinite lenalidomide.  They ended up abrogating it because of their concerns for toxicity.  The patients in that study had about 18 months of lenalidomide.  

And then lastly there's a big trial that's going on right now that the IFM Dana-Farber trial that in this French part patient after transplant might get lenalidomide only for a year.  The U.S. part patients get lenalidomide indefinitely, so it tells you that, you know, we can't really—don't know and we can't agree.  

The last point I would say is a trial, which you're very familiar with, Jack—you've been hugely instrumental in getting it off the ground, is trying to answer that very question, which is transplant get randomized to lenalidomide or lenalidomide and daratumumab (Darzalex), and then after two years if they're MRD negative, so really looking very, very deeply at their myeloma, patients will have a second randomization, so a group of patients both stop therapy, so that will answer the question can you stop therapy if you've had a very, very good response.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.