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Why Chemo and Maintenance Therapy for High-Risk Myeloma After Stem Cell Transplant?

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Published on February 10, 2016

In this Ask the Expert segment with Dr. Robert Orlowski, Cammie, a high-risk patient who is currently recovering from a stem cell transplant asks, I'm very concerned about being back on dexamethasone, Revlimid and carfilzomib for such a long period of time. Can you offer any insight?

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This Ask the Expert series is sponsored by the Patient Empowerment Network, which received funding from Celgene, Novartis and Takeda.

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Transcript | Why Chemo and Maintenance Therapy for High-Risk Myeloma After Stem Cell Transplant?

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.           

Andrew Schorr:     

Here’s a question that came in from Cammie,  “I was diagnosed with multiple myeloma in March of 2015, and I started treatments with dex[amethasone] (Decadron), lenalidomide (Rev[limid]) and carfilzomib (Kyprolis) in April of that year followed by a stem cell transplant in fall, September.  And I’m recovering from the transplant now.”  She only had it in September.  “And I’m scheduled to begin treatments again that will last about another 12 months.  I’m very concerned about being back on these drugs for such a long period of time.  I’m a high-risk patient, and I have the”—is it the T14 gene? 

Dr. Orlowski:     

The (4;14) translocation.

Andrew Schorr:                  

(4;14), yeah, yeah.  Can you offer any insight?  She’s just worried about heavy-duty treatment going forward after the transplant.  She’s been through a lot. 

Dr. Orlowski:     

Definitely.  Well, thanks very much, Cammie, for that question.  Patients who have higher risk disease do usually need a little bit more aggressive treatment, we think, even after stem cell transplantation.  So while for the so-called standard risk patients maintenance after transplant with just lenalidomide as the single agent is probably okay, the tendency has been for the higher risk patients to treat them either with some consolidation chemotherapy, which is sort of similar to induction except it’s given after transplant, and then to follow that with some maintenance therapy as well.  We think that that has a benefit. 

We don’t know for sure, because the studies haven’t yet been completed, for example, within SWOG, which is one of the cooperative groups.  We have trials specifically for high-risk patients.  Also, it depends a little bit on how much myeloma is left over after the transplant.  Because if there is still some myeloma left over, then the rationale to try to keep hitting it hard to get it into remission is stronger.  Whereas if maybe she’s already in MRD negativity, maybe just maintenance by itself would be sufficient. 

So I don’t think we have enough information right now here, but there are a couple of different options that need to be thought about, and maybe consulting with a myeloma expert would be a good idea. 

Andrew Schorr:                  

Right.  Cammie, good suggestion.  I know you’ve been through so much.  You say, “Oh, my God.  I had the induction therapy, I had the transplant, give me a break, and can I have sort of treatment light, in a way, to manage 

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. 

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