The Latest Myeloma News from the American Society of Hematology Meeting

Andrew Schorr:

Okay. Thank you for that. So, Jim Berenson, and I want Dr. Lonial to answer this too because I don't know if you guys are going to agree here, and that's fun for me. Derrick from San Diego writes, and he says, 'With the availability of many new drug combinations now, is there a role for transplant in the age group 55-70?' Dr. Berenson, you first.

Dr. Berenson:

Right now, no, I'm not transplanting actually anybody who has myeloma given all these new therapeutic options, and I think that in my experience, there probably is a very small minority of people that do benefit from transplant, and there is probably a small minority who actually make the disease worse not only in terms of toxicity but turn it into an angry gorilla, and I'd say the very vast majority we really have done nothing. So, I remain to be convinced, so I am not a transplant-heavy person at this point. I mean, we'll see what the results are. I, for example, wonder if the patient's on these Velcade combination trials, if they remain on those, would they do just as well as having going through a transplant? We really don't know that answer from the way these trials were designed. One of the questions is whether the newer therapies can replace that, and unfortunately I have to drift off now because I have another teleconference to run on, but I appreciate you're having me here.

Andrew Schorr:

We'll let you go. Thank you Dr. Jim Berenson.

Dr. Berenson:

Thank you very much.

Andrew Schorr:

Thank you. Dr. Lonial, I know you may have to go too. Can you just comment because you still do perform transplants, whether we'll still at an age where we need to continue that as an option for some people? Dr. Berenson doesn't think so for most people. Where are you with this right now?

Dr. Lonial:

Yes, I think in many ways it depends on the response to the initial induction therapy. So our approach when we use the three-drug combination is that patients who achieve a complete remission with induction therapy, we will collect their stem cells but try and maintain them on therapy and see how long that first remission really lasts, whereas patients who are not in a complete remission early on, we'll collect their stem cells and use the transplant as a mechanism by which to get them into a complete remission. So, I think there is a role for transplant. I think that there is clearly a role for collecting stem cells, and the reason I say that is if we're talking about using multiple therapies as a chronic, long-term effect, then I think we need to make sure that if we run into problems with low blood counts three and four years from now, because of all the therapy we've given, that we have some way out, and that's that the stem cells provide. They give you an opportunity to sort of reset the bone marrow at a point when if you've delivered four or five different kinds of the treatment, and the white count is low, and the platelets are low, and you just can't get effective therapy in, you may be able to do that with a salvage transplant, where you give them normal counts once again. So, I think there are a number of reasons to think about collecting cells, about the role of transplant, and I think the timing of that really depends in many ways on the response patients have to their initial induction.

Andrew Schorr:

Dr. Sagar Lonial, thank you so much for being with us. We're going to let you go. I know the doctors are running around because there's so much conversation going on doctor to doctor now with the news from ASH. Thank you for being with us from the Winship Comprehensive Cancer Center.

We'll continue with Dr. Durie for a minute and warn Dr. Heffner we're going to have a lot of questions for him next week, okay?

Dr. Lonial:

Absolutely. Thank you for the chance to be here.

Andrew Schorr:

Thank you, sir.

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Page last updated on November 22, 2013