Is high dose chemotherapy and transplant the best treatment for multiple myeloma?
Submitted by Dr.Kattlove’s Cancer Blog
I have been mulling this question over in my mind for years. I’ve never felt the evidence was that convincing. I’ve known of people who had the procedure and quickly crumped. Also, maybe the results look good because the people who go to these centers for the transplant have to be in pretty good shape just to get there.
All this came to me today as I read of the death of the actor Roy Scheider, who made it big as the sheriff in the movie “Jaws” but who I admired as the Bob Fosse character in the movie “All That Jazz”. He died of multiple myeloma at the University of Arkansas Medical Center in Little Rock, only, I read, 3 years after his diagnosis. This is a major center of myeloma treatment and one where the stem cell transplant has been a favorite. In fact, these people have been its champions, so I suspect he had the procedure.
Now the truth is that the procedure really isn’t a transplant. A patient’s own cells, not someone else’s are used. The way it goes is this. First the patient with myeloma gets standard chemotherapy to control the myeloma and get rid of as many of the cancerous myeloma cells as possible. Then his blood is filtered in special machines to remove the blood-forming stem cells. These are stored while the patient then gets massive doses of chemotherapy, often along with some radiation to kill most of the rest of the myeloma cells. At the same time, this treatment kills all the patient’s blood-forming cells. That is why they need to be replaced. Once the chemotherapy and radiation are finished, his blood-forming stem cells are transfused back into him and they head for the bone marrow where they will start making blood cells again.
This treatment isn’t curative and isn’t for everyone. It is quite toxic; most centers use this only for patients younger than 65. That leaves out two-thirds of myeloma patients. Also, I’m not sure that today it is the best treatment available even for younger patients. When the transplants first were developed, they did seem a little better than the usual treatment according to the studies at that time. In these early trials, half the patients got the high dose chemotherapy and perhaps radiation followed by the stem cells, while the other half received the standard treatment of that time. In those studies, the high dose chemotherapy patients appeared to live a little longer.
But the standard treatments in those studies aren’t the standard ones today. New drugs have been developed. In fact, new myeloma drugs have been some of the hottest items in cancer therapy in the last few years.
Just this week I read of a report of a totally new combination treatment of three drugs to treat myeloma. These are Biaxin, Revlimid, and dexamethasone. The first two are new and the last an old-timer. The overall survivals in the myeloma patients who received these were as good as we see with transplants. And, although some of the patients did get high dose chemotherapy and transplants after this treatment, they didn’t do any better than patients who didn’t get the high dose chemotherapy and transplant. In fact many of these other patients were also supposed to get the high dose chemotherapy and transplant, but were feeling so good, they passed.
With all these new drugs we need new studies to see if transplants are still number one. Until then, I’d be awfully cautious about going for the transplant when there are so many good drugs around.
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