Hi Judy!

I found this information on cancernetwork.com…

Nationally, we still have up-front transplant as a standard of care, and it’s based on the IFM 2009 trial, which randomized patients to get RVd [lenalidomide, bortezomib, dexamethasone] followed by maintenance or RVd [lenalidomide, bortezomib, dexamethasone] with transplant and then maintenance. There was a progression-free survival [PFS] advantage for those who got a transplant. It was a 1- to 2-year difference, which is pretty significant in the long run for patients with myeloma.

More recently, the results of the DETERMINATION trial were published in NEJM [New England Journal of Medicine], which had 2 arms: an arm with RVd [lenalidomide, bortezomib, dexamethasone] induction followed by transplant and then maintenance vs induction followed by maintenance, which would continue to progression. There was a good number of patients, 300-plus in each arm. In that study, the patients who didn’t get the transplant had a PFS of around 3 years. In the other arm, in the ones who had transplant, it was 5 to 6 years. You’re seeing a 2-year difference in PFS.

Hi. I’m an 81 yr old woman, diagnosed in 2020, 80 when I had my SCT last Oct. (2022). Dr. was reluctant, at first, to have me go though it because of my age but gave me the choice eventually because of my overall good health. It was grueling, to say the least, but I persevered and was given a clean bill of health as in “remission” in Feb. I’m very grateful for the procedure and the result. I’m still quite fatigued and back achy but much of that can be blamed on arthritis. I’m taking a low dose of Pomalyst (a sister of Revlimid), and so far I’m doing well. I would encourage your husband to sign up for the ride as long as his Dr is giving it a thumbs up. Best of luck to you both! Caregivers are HEROES!

Thank you!!! I have printed the article and it seems to have the kind of info I am looking for.

This information was found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC68...

A large randomized, open-label, phase III trial carried out by the IFM group randomized patients to receive induction therapy with three cycles of bortezomib, lenalidomide, and dexamethasone (VRD) and then consolidation therapy with either five additional cycles of VRD or ASCT followed by two additional cycles of VRD. Both groups received maintenance therapy with lenalidomide for 1 year. The ASCT group had significantly improved median PFS (50 months versus 36 months; p < 0.001), the percentage of patients with a complete response (CR) (59% versus 48%, p = 0.03), and the percentage of patients who achieved minimal residual disease (MRD) negativity (79% versus 65%, p < 0.001), when compared with the VRD group. There was, however, no difference in OS at 4 years. The findings of these phase III trials, demonstrate consistent benefit in terms of higher response rates, degree of response, and improved PFS for ASCT compared with the more contemporary therapies, has led to the current recommendation that continues to support the incorporation of ASCT into the MM treatment process.

Although most trials evaluating ASCT in MM historically used an age cut-off of ⩽65 years old to select eligible patients, the number of patients undergoing ASCT in older age groups has significantly increased over the past years. Many studies have shown that age alone does not have any effect on the outcomes following ASCT in patients with MM. An analysis of 946 MM patients aged ⩾70 years at ASCT by the Center for International Blood and Marrow Transplant Research (CIBMTR) showed that older subjects selected for ASCT obtained similar antimyeloma benefits without higher nonrelapse mortality, relapse rate, or PFS. A study of 207 MM patients aged 70–76 years old at ASCT treated at the Mayo Clinic showed that ASCT was well tolerated and had noninferior PFS and OS when compared with younger patients.

How long have you been in remission, Jeff8 and are you on maintenance meds?