Tag: SCT

Prognostic Factor for myeloma patients after ASCT

Multiparameter Flow Cytometric Remission Is the Most Relevant Prognostic Factor for Multiple Myeloma Patients Who Undergo Autologous Stem Cell Transplantation
Blood. 2008 Nov 15;112(10):4017-4023, B Paiva, M-B Vidriales, J Cerveró, G Mateo, JJ Pérez, MA Montalbán, A Sureda, L Montejano , NC Gutiérrez, A García de Coca, N de las Heras, MV Mateos, MC López-Berges, R García-Boyero, J Galende, J Hernández, L Palomera, D Carrera, R Martínez, J de la Rubia, A Martín, J Bladé, JJ Lahuerta, A Orfao, JF San Miguel, on behalf of the GEM/PETHEMA cooperative study groups

Minimal residual disease (MRD) assessment is standard in many hematologic malignancies but is considered investigational in multiple myeloma (MM). We report a prospective analysis of the prognostic importance of MRD detection by multiparameter flow cytometry (MFC) in 295 newly diagnosed MM patients uniformly treated in the GEM2000 protocol VBMCP/VBAD induction plus autologous stem cell transplantation (ASCT).

MRD status by MFC was determined at day 100 after ASCT. Progression-free survival (PFS; median 71 vs 37 months, P < .001) and overall survival (OS; median not reached vs 89 months, P = .002) were longer in patients who were MRD negative versus MRD positive at day 100 after ASCT. Similar prognostic differentiation was seen in 147 patients who achieved immunofixation-negative complete response after ASCT. Moreover, MRD− immunofixation-negative (IFx−) patients and MRD− IFx+ patients had significantly longer PFS than MRD− IFx+ patients. Multivariate analysis identified MRD status by MF Cat day 100 after ASCT as the most important independent prognostic factor for PFS (HR = 3.64, P = .002) and OS (HR = 2.02, P = .02). Our findings demonstrate the clinical importance of MRD evaluation by MFC, and illustrate the need for further refinement of MM response criteria.

Autologous Stem Cell Transplantation in Patients of 70 Years and Older With Multiple Myeloma: Results From a Matched Pair Analysis

Thanks to Carol for finding this new study.

Autologous Stem Cell Transplantation in Patients of 70 Years and Older With Multiple Myeloma: Results From a Matched Pair Analysis
Am J Hematol. 2008 Aug 1;83(8):614-617, SK Kumar, D Dingli, MQ Lacy, A Dispenzieri, SR Hayman, FK Buadi, SV Rajkumar, SV Rajkumar, MA Gertz

Multiple myeloma (MM) accounts for 1% of all malignancies and approximately 10% of all hematologic malignancies. In the United States, an estimated 19,900 new cases of MM were diagnosed in 2007, and 10,790 patients were expected to die of this disease. Patients with MM have a median age of onset in the seventh decade of life and 3- to 4-year median survival when treated with conventional chemotherapy. Newer combination chemotherapeutic agents have not improved the survival outcome achieved with melphalan and prednisone, which have been used for >30 years. High-dose chemotherapy (HDT) followed by autologous stem cell rescue has resulted in improved survival and quality of life compared with conventional strategies. For patients with MM who qualify for HDT, this approach has become the standard of care.

Many of the larger clinical trials in which HDT was examined only included patients <65 years of age. However, a significant proportion of MM patients are >65 years. Therefore, it remains unclear whether the benefits observed in younger patients would extend to an older population. This case-controlled study evaluated the outcome of HDT in patients with MM who were >70 years.

A total of 93 patients were included in the study. All had undergone HDT and stem cell transplantation for MM. The study group included 33 patients >70 years and a matched control group of 60 patients <65 years. The baseline characteristics of the 2 groups were comparable, with the only difference being the type of conditioning regimen used. The dose of the melphalan conditioning regimen was reduced in 30% of patients in the elderly group as opposed to only 5% of patients in the younger group.

A trend toward a longer hospital stay after transplant was noted for the elderly vs the younger group (8 vs 3 days). By day 15, engraftment occurred in 94% of the elderly group vs 78% of the control group (P = .08). The adverse reactions most often seen were nausea, vomiting, hypertension, and tachycardia; no significant differences between the groups were evident. The overall response rates were 97% and 98% for the elderly and control groups, respectively. A complete response was achieved by 42% of the elderly group vs 28% of the control group. The patients were observed for a median of 27.2 and 38.3 months in the elderly and younger groups, respectively. The post-transplant median overall survival duration was 53.3 months in the younger patient group; the elderly patient group did not reach its median overall survival during follow-up. In the subset of patients receiving reduced-dose melphalan, there was no difference in time to progression or overall survival compared with
patients receiving standard-dose melphalan.

Previous trials have clearly shown a benefit of HDT in patients <65 years of age. However, investigators have not studied the benefit of HDT for patients 70 years of age and older. This study showed that patients older than 70 years have outcomes similar to those in younger patients (<65 years of age). The treatment-related mortality rate and the kinetics of engraftment were similar between the 2 study groups. Despite a greater proportion of the older group of patients receiving a reduced dose of melphalan, no significant differences were evident with respect to response rate or time to progression between the 2 groups. This retrospective study showed a benefit for patients >70 years who underwent HDT for MM. Age alone should not be the sole factor used when evaluating whether a patient is eligible to undergo HDT. Dose reduction should be considered for the older population of patients when appropriate.

MMSupport.net unveils “Ask the Expert”, featuring Multiple Myeloma physician and scientist, James R. Berenson, M.D.

MMSupport.net unveils “Ask the Expert”, featuring Multiple Myeloma physician and scientist, James R. Berenson, M.D.
 
Ask the Expert is a free online web-forum where Myeloma and Bone Cancer specialist, Dr. James R. Berenson offers medical answers to questions surrounding quality of life and longevity issues for patients living with this rare form of cancer.
 
Los Angeles, CA – MMSupport.net and the Institute for Myeloma and Bone Cancer Research are proud to announce the creation of “Ask the Expert”, a free online web-forum featuring Multiple Myeloma expert, Dr. James R. Berenson.
 
MMSupport.net is the creation of myeloma-advocate, Beth Morgan.  The website serves to foster community in the form of an online forum where patients and caregivers could learn more about Multiple Myeloma, a plasma cell cancer that resides in the bone marrow.  Thousands of people visit MMSupport.net every day.  Many visitors are Myeloma and Bone Cancer patients, caregivers and other medical professionals who actively participate in online discussions about treatment options and personal experiences.  “Ask the Expert” is the latest addition to the MMSupport.net website and is available at no charge by registering on the site.  Visit www.mmsupport.net for more information.
 
James R. Berenson, MD has 25 years experience in treating Multiple Myeloma and Bone Cancer patients.  Dr. Berenson is CEO and Medical Director for The Institute for Myeloma and Bone Cancer Research and CEO and President of Oncotherapeutics, an oncology-specific clinical trials management service.  Dr. Berenson is an active clinician who treats patients daily in his Los Angeles offices and acts as a specialist consult to patient’s primary oncologist or primary care physician throughout the world. For more information, visit www.berensononcology.com
 
The Institute for Myeloma and Bone Cancer Research, based in Los Angeles, California, is an independent cancer research institute with a primary focus on hematologic cancers.  Established in 2004, the IMBCR is a 501 c (3) non-profit organization.  Over the last four years, the IMBCR has created novel breakthrough therapies that have substantially increased the longevity and quality of life of myeloma patients. The latest initiative at the institute is “The Cure Myeloma Project”, a multi-year research project that targets myeloma cells while keeping the non-cancerous cells intact.  For more information or to make a donation, visit www.imbcr.org
 
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Media contact:
Beth Morgan, MMsupport.net beth.morgan@connectnc.com or,
Cheryl A. Cross, MPH, Institute for Myeloma and Bone Cancer Research ccross@imbcr.org 866-900-1035

Sad News

I got some sad news today.  My e-mail friend and frequent commenter on this blog, Judith Meuli (Jude), passed away yesterday. Like me she had IgA MM, although hers was kappa light chain. We shared stories about living with MM and other things. She had let me know that her doctor had told her this would be her last year. I plan on making a donation to the IMF and the IMBCR in her memory. Jude was mom’s age.

Special Edition: Multiple Myeloma Series Upcoming Webcast

Special Edition:  Multiple Myeloma Series
Upcoming Webcast:
This year’s American Society of Hematology meeting in Atlanta has brought many exciting new developments.  Join us this Friday for our discussion with two experts, Dr. Brian Durie, Founder, a Myeloma Specialist and Chairman of the Board for the International Myeloma Foundation and Dr. James Berenson, Founder, President & Chief Executive Officer of the Institute for Myeloma and Bone Cancer Research.  You’ll hear the latest groundbreaking news from the meeting and what these two renowned experts are excited about in Myeloma treatment and research.

“The Latest Myeloma News from the American Society of Hematology Meeting”
Friday, December 14, 2007, 2:00 pm Eastern (11:00 am Pacific)
Sponsored through an educational grant from Millennium Pharmaceuticals, Inc.
For a schedule of upcoming webcasts, to listen to recent myeloma program replays, and for further information, visit http://www.patientpower.info/specialeditionlymphoma.asp.

 

Featured Guests:

 

Brian G.M. Durie, M.D. is Chairman of the Board of the International Myeloma Foundation and a myeloma specialist at Cedars-Sinai Comprehensive Cancer Center in Los Angeles. He is also a member of the IMF Scientific Advisory Board. Dr. Durie is the recipient of the Leukemia Society of America Scholar award and the U.S. Hematologic Research Foundation Annual Award, among many others.

 

James Berenson, M.D. is the Founder, President and CEO of the non-profit Institute for Myeloma and Bone Cancer Research (www.imbcr.org) and Berenson Oncology (www.berensononcology.com) in Los Angeles, California. A leading physician-scientist, Dr. Berenson has specialized in cutting-edge research related to myeloma and metastatic bone disease both in the lab and with patients for 20+ years. He has been involved in many of the major breakthroughs that have brought new treatments for patients with these diseases resulting in both an improvement in the length and quality of their lives. His latest initiative, “The Cure Myeloma Project” enlists the work of a full-time research staff engaging in rigorous pre-clinical and clinical trials, using human myeloma cells.

Andrew Schorr: Host and eleven-year CLL survivor

HOW TO PARTICIPATE:
Listen live at http://www.patientpower.info/specialeditionmyeloma.asp
Call in live 877-711-5611 or Email questions to andrew@patientpower.info  
ABOUT PATIENT POWER:
Patient Power is a weekly show hosted by Andrew Schorr, ten-year leukemia survivor, patient educator and patient advocate.  The show features renowned medical experts on topics that include cancer, pain, diabetes, and heart specialists, as well as experts in clinical trials and top pharmacists.  The show serves to bring patients together in a radio and Internet community to provide information about available treatment options.  Patient Power takes questions from callers and Internet listeners on topics such as how to find the right doctor, how to advocate for effectively, when to get a second opinion from a specialist and how to evaluate one treatment option over another.

Some lab values

I got the results of the tests done Monday at Duke. The full report was faxed to my office, and I haven’t seen it yet, but here’s what I have so far.

M-Spikes (I have two m-spikes)

Last month: 0.19 and 0.12 g/dL (Total is 0.31 g/dL)
This month: 0.16 and 0.22 g/dL (Total is 0.38 g/dL)

Immunoglobulin Profile

Last month: IgA 374 mg/dL Reference: 46-287
This month: IgA 465 mg/dL Reference: 46-287 (up 91)
Last month: IgG 709 mg/dL Reference: 588-1573
This month: IgG 603 mg/dL Reference: 588-1573 (down 106)

I have July and August here. Needless to say, I was fervently hoping for a drop in the IgA and an increase in the IgG.  The one good thing is that the IgG is still in the normal range, where it has never been since I learned I had MM.  It was usually below 300 mg/dL.

Can someone give me a good explanation about why I have two m-spikes? I’ve asked doctors about a zillion times, and I have either forgotten what they told me or didn’t understand it well enough to even remember.

Hair Update

I thought I’d give a visual progress report of my hair growth.  Here’s a picture I took today.  You can compare it to one I took on October 13, 2007.

Hair growing back after stem cell transplant

Kind of weird, huh?  And, not too attractive. My hair started to fall out in September, after I had high dose chemo (melphalan) on August 28th. Some spots still look bald, even though there’s a covering of very fine, nearly invisible hair.

I had a follow up appointment at Duke today.  I won’t have any results until Wednesday afternoon.  Not anything important, anyway.  I didn’t even bother getting a copy of my CBCs. Dr. Long just told me they were completely normal. Throughout my entire MM experience, my CBC’s have hardly ever been anything but normal.