Michele L. Donato, MD
Chief, Adult Blood and Marrow Stem Cell Transplantation Program – John Theurer Cancer Center
I have been a transplant specialist for about 18 years and one of the things I hear all the time from patients who come for a consultation is “my doctor does or does not believe in transplant”. My answer usually is “it’s not a question of belief, transplant is not a religion”. The right decision should be based on the medical data, not random beliefs. So, here are a few facts about autologous transplantation for multiple myeloma.
- Autologous transplantation is considered the standard of care for patients under the age of 65 with newly diagnosed multiple myeloma. Transplantation has been shown to improve the survival and the duration of remission of such patients. This was first demonstrated by Dr. Attal in 1996 (yes the French were first…), and corroborated by several follow up studies.
- What if you are above the age of 65? As I am entering my late 40s I certainly have a new perspective on age. I am embracing my age and embracing my older, wonderful patients. I also think that it is fair to say that in 2016, people are aging differently than our grandparents. Many patients above the age of 65 are in excellent health. Case in point, Olga Kotelko was a track star at the age of 94 (Google her… she is amazing!). So let’s not discriminate.In 2014 Dr. Sharma and colleagues analyzed more than 10,000 patients with multiple myeloma receiving autologous transplantation. They looked at 3 groups: ages 18-59, ages 60-69, and ages 70 and above. Well, you guessed it, older patients did just as well in terms of duration of remission and risks of the transplant.
- What is the role of transplantation, now that there are new drugs for multiple myeloma? A very recent publication by Dr. Palumbo in the New England Journal of Medicine compared patients who received an autologous transplant to patients who received a lenalidomide (Revlimid)-based regimen without a transplant. Patients who received an autologous transplant had an improvement in their duration of remission and in their overall survival.
So at the very least, if you are newly diagnosed with multiple myeloma, I would strongly encourage you to meet with a transplant doctor. Getting information, being engaged, will give you power and strength.