Is it possible to have no response to transplant? Yeah, you know, it doesn't happen very often anymore because before when we started to do the transplant, actually the first transplant were done in the 80s, it became standard of care in the 90s. We were using different type of preparation, right? The VAD, the v-cristine, adria, Daxa, the pulse dose, Daxa. So we were bringing everybody to transplant even with a partial response, with suboptimal response. Now it's not the case. We do this combination, the Darzalex with the Borthosoma, Balenalidomide, Daxa. The majority of patients are able to respond quickly. We achieve deeper response. And so the transplant works because you are, you know, it's the last, the high dose chemotherapy kills the residual, there is a better penetration. So more patients are able to achieve the minimal residual disease. There are patients, the transplant doesn't work and you see the progression very rapidly and those are the patients that you really need to treat outside the box because the chemotherapy doesn't impact on their myeloma. But, you know, you don't see really a lot of patients going out of transplant without a response. It will be like, you know, unlikely now because they all come. Some, they're already in remission. So we prepare. So the transplant is not perfect, right? The myeloma will come back eventually. So how you can improve the transplant with a better induction, with a better treatment before the transplant. So you can go to transplant with a better response and after with a consolidation if it's necessary with the maintenance, right? So the transplant is in the middle and then you can improve it before and after or change the chemotherapy of transplant. And that's the reason why more patients are able to remain in remission for many years because the induction is better than you have the transplant and then the maintenance, right? Which clearly keeps patients from relapsing for many years.
HealthTree • November 12, 2021
