Which myeloma patient is stem cell transplant most appropriate for? Dr. Joshua Richter reviews the factors that go into the decision, as well as the risks and benefits of this treatment approach.
Dr. Joshua Richter is director of Multiple Myeloma at the Blavatnik Family – Chelsea Medical Center at Mount Sinai. He also serves as Assistant Professor of Medicine in The Tisch Cancer Institute, Division of Hematology and Medical Oncology. Learn more about Dr. Richter, here.
How do you determine if stem cell transplant is appropriate?Katherine:
So, stem cell transplant has been a key component for the treatment of myeloma for many patients for decades.
It’s a tool; it is not the only tool. So, it’s a very complex decision deciding who should receive a transplant and who should not. Outside of the U.S., there are very strict guidelines. In many places in the world, over the age of 65, you do not receive a transplant outside of being involved in a clinical trial.
In the U.S., there is no age restriction. But it’s an ongoing discussion between the patient and their care team about the risks and benefits. The older you are and/or the other comorbidities you have, other medical problems, may make it too risky to do. There are some people that we can control their disease for extremely long times without the need for transplant. One of the things that weighs into it is how well did you respond to your first therapy. We have some emerging data that if you have such a great response to your initial treatment that you have no measurable disease at all even in the bone marrow, you may not even need a transplant.
So, the decision of who needs it and who doesn’t is evolving. From my standpoint, I consider it for any person who is healthy enough to go through it and who has a clear understanding of the risks and benefits.
I’m a strong proponent of it, but because there are such great new drugs, it’s a moving target.