Multiple Myeloma Life Expectancy –  The Allo,  Is it a Cure or just a very Risky Treatment of Last Resort

***You can listen to a comprehensive Cure Panel discussion of the Pros and Cons of the Allogenic Stem Cell Transplant presented by Dr. Ravi Vij of the Washington University.  You can listen if you just CLICK HERE.***

The Allogenic stem cell transplant (the use of someone else’s stem cells, a donor) has been one of the most debated treatment options that confronts the myeloma patient community.  It is used more extensively in other cancers like leukemia, and lymphoma, and has not been a staple of care for myeloma.  Some people feel it is the only possible way of achieving a Cure, however with the success of new novel therapies and use in conjunction with the autologous stem cell transplant (the use of your own stem cells) others feel the allo is just too risky unless you have exhausted all other options.  

The majority of myeloma specialists do not feel the use of the allo is appropriate as a first line therapy, and I believe it has to do with the history of TRM(transplant related mortality).  If you look at the following graph it will show you the history of mortality each year after transplant for the period between the years 2000 and 2010.  This graph is from the CIMBTR which is a group of 500 transplant hospitals. You can find a slide presentation from the CIMBTR of everything that you ever wanted to know about transplant statistics if you just CLICK HERE.


If you look at this information the auto has always provided a survival advantage over the allo for at least the first 6 years. The first year mortality is 5% for the auto, 30% for the allo(sibling donor) and 50% for the allo(unrelated donor) I know of several people who have had allos, and find that at least those I know seem to be doing quite well.  Some have had it as a primary therapy, and others who have had it as a last resort therapy.  Because I know them, I must conclude they are either the lucky ones who have survived or they have found a safer allo than that represented in these graphs.  

I have heard anecdotal information from two people in my support group that Moffitt in Tampa uses Velcade post transplant as part of there protocol and this has reduced the mortality to acceptable levels, however I have not seen any numbers that support this.  The Velcade helps to reduce the impact of GVH (Graft vs Host disease) to acceptable levels.  I can see how the use of the sibling donor transplant and that of an unrelated donor would become far more widely used if the one year mortality was closer to 10% than to that of 30 to 50% noted in the historic numbers.   
I know I am looking forward to finding out more about the allo, and getting some input and great questions from the Jack, Mark, and Arnie’s of the post allo myeloma patient community.

Good luck and may God Bless your myeloma journey/Gary Petersen

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