Is it possible to have no response to transplant?

Is it possible to have no response to transplant?

Most people respond to a transplant. But like any cancer therapy, there are always some people who don't. And there's been a long interest in trying to figure out, you know, can we have can we come up with tests that will predict sensitivity to treatments? But, you know, this issue of sort of we have a therapy and can we find markers that predict sensitivity? I think we're still a long way, unfortunately, from getting there.

As of now, there's nothing we do. We don't test people before doing a transplant to see if the transplant is going to work. You know, I anecdotally, I'd say probably less than 5 to 10% of patients. We don't either we don't see a benefit or we see the things get worse, which is even, you know, harder. So it's not a high percentage of patients, but it definitely happens.

And I think one thing I always counsel people on with the transplant is, you know, there's no guarantee that this will work. It probably will. The odds are definitely stacked in your favor. But it's not a perfect treatment. And no, no cancer treatment is. And so that's, I mean, I always try to make people aware that mainly because I've seen it happen.

What happens if transplant doesn't work for an individual? What I can tell you is it's not, it's not a doom and gloom conversation. Okay. What it means is we gave a treatment that didn't work. For many patients where I've had this happen, it's not, it's not the end of the world. We can start maintenance, we might start some kind of consolidation, and we can turn things around.

I have one patient, you know, where we started on maintenance, and over time, M-protein just went down. But this issue where there's just no response but things are sort of stable. I mean, that for me has, not always been a bad outcome.

It doesn't happen very often anymore because before when we started to do the transplant, actually the first transplants were done in the 80s. It became standard of care in the 90s we were using a different type of preparation. Right. The VAD, the Vicristine, Adria dexa, the pulse dose dexa, So we were bringing everybody to transplant, even with a partial response with suboptimal response.

Now is not the case that, you know, we do this combination, the, the Darzalex with the Bortezomib, Lenalidomide, Dexa, the majority of patients are able to respond quickly. We achieve deeper response. And so the transplant, you know, works because you are, you know, the last high dose therapy 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 the response. It will be like, you know, unlikely now because they all come some day in remission.

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 the 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.

So because the induction is better then you have the transplant and then the maintenance, right, which clearly keeps patients from relapsing for many years. To learn more about induction therapies used in multiple myeloma, watch lessons on this topic in the HealthTree University course entitled Starting Myeloma Therapy.