Ask the Expert about the Latest Myeloma News

Andrew Schorr:

Yes, I think that's great advice. That's what I did in my leukemia, and it gave me a lot more confidence, and I think my community oncologist really appreciated it and appreciated the connection with a specialist in my illness because my community oncologist had to worry about colon cancer, breast cancer, and prostate cancer, everything, and so I think he appreciated the connection with a specialist. The way it worked out for me, and it might for you our listeners and certainly people who are newly diagnosed is, a myeloma specialist like Dr. Lonial, if you have a consultation with them, may in the end make a recommendation that can be a blueprint for your care with the new landscape in myeloma treatment and then hopefully with the concurrence of your local specialist. It's not to put them down; it's with a great deal of respect. They may be sort of the general contractor. They may be delivering the care according to a plan that was recommended by a myeloma specialist, and then that relationship, that dialogue continues really over the rest of your life, and I think that's very valuable.

Dr. Lonial, just a couple of other questions. I don't want to beat a dead horse, but there's been debate on our programs before depending upon who the practitioner is who has been on, and you've been part of that, the role of transplant now. I know some of the studies came out and talked about how to make transplant more effective. So what's your view at Emory now about the role of transplant? Still very valid and are there now drugs to help it be better?

Dr. Lonial:

I think that, to answer the second question first: Are there drugs to help it be better? We actually have an ongoing phase-II trial combining bortezomib or Velcade with high-dose melphalan and have shown a very high response rate for patients who essentially did not have a good response to their initial induction therapy. So I think that there are ways to enhance the efficacy of high-dose therapy by using novel drugs either as part of the induction or as part of actual transplant maneuver itself.

I think to answer the first question; there are a lot of emotional issues on both sides of the transplant issue. Should you have a transplant? If you go to one transplant meeting, the answer is yes for everybody. If you go to another meeting, you may hear everybody say, 'No, transplant has no role,' and I think that the answer is probably somewhere in between.

In our approach is that for young, well patients we will collect grafts on everybody, and the real question for us becomes when do we transplant? Do we transplant early on in the setting of first remission, or do we transplant in the setting of first relapse, early on in first relapse? And are there subsets of patients for whom high-dose therapy may not offer much of a benefit at all, and that's something we didn't know five and ten years ago when a lot of these studies were done, but I think we're identifying potentially cytogenetic subsets of patients that don't seem to gain a lot of benefit from high-dose therapy as well as cytogenetic and FISH subsets of patients that may actually gain a lot of benefit from high-dose therapy and autologous transplant.

So I think it's a moving target, and if you hear, and I'm always a little cautious of people that are too much on one extreme or the other; no, it has no role; or yes, you have to do it for absolutely everybody. I think that somewhere in the middle is probably the best way to look at it, and there's not a downside to collecting stem cells early on in the course of a patients disease so that you always have options later on.

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