Posted on March 05 2014 by Pat Killingsworth | 389 views
We spend so much time hoping and praying for a cure. Could it be that for some, a cure already exists?
Most of you should already be familiar with Total Therapy (TT). Developed over decades by Dr. Bart Barlogie at the University of Arkansas School of Medical Sciences (UAMS), TT is often criticized for being unnecessarily toxic and intense. Yet as time goes by, TT has been producing some impressive numbers; half of low risk patients treated this way are living at least ten years.
But the question remains: do these impressive survival numbers prove some of these patients are cured? Well read blogger and myeloma survivor, Nick Van Dyk, is part of the TT success story. He was kind enough to jot down some of his thoughts about it:
I believe that Total Therapy represents a potentially curative option for a meaningful subset of newly diagnosed patients and can exceed a 50% cure rate for patients in the right population. Patients who have (1) not undergone meaningful amounts of previous treatment for the disease, who are (2) young enough to benefit from the additional lifespan beyond the potential 5-10 years that less invasive therapy generally provides in a successful case, who are (3) healthy enough to receive multiple courses of chemotherapy including two high-dose courses of Melphalan, who are (4) psychologically prepared to embrace an aggressive treatment protocol and who are (5) prepared for the logistics of an extended stay at a center of excellence for this treatment (whether Little Rock, Iowa, etc.) should consider that, if they are in the 85% of patients with “low risk” disease, they have a better than 50% chance of being cured.
Does this statement with all its qualifications mean that Total Therapy constitutes a cure for the disease? Biologically, it probably constitutes a good shot at it for those that are otherwise healthy. Psychologically, not all patients are prepared for it — and I think that’s in part because they have been led to be terrified by the concept of a transplant, which is a shame. For the older diagnosed patient (Tom Brokaw comes to mind), the incremental few years of life in his late 80s may not be worth the added intensity of treatment versus the less invasive program he is receiving at Mayo. For the high risk patient, unfortunately, few if any cases are cured through existing treatments. But still — for someone like me, diagnosed at 40, otherwise healthy, and prepared to fight like hell — the chance of a cure is not some shot in the dark, 2% chance. It’s even money or better — and once one achieves remission and maintains it for a period of time, it approaches certainty. Whether that period of time is 6 years, as BB (Dr. Bart Barlogie) and team now maintain, or some longer time frame as Rajkumar appears to suggest, it’s out there. Dr. Rajkumar agrees with that much, and notes that people were cured 20 years ago with Melphalan and Predisone — just not very many.
BB and Total Therapy are curing a meaningful portion of patients that undergo Total Therapy. Patient empowerment and a gradual broadening of the centers that offer Total Therapy as a choice should increase the reach of this alternative, and that’s a good thing.
My thoughts? It’s clear to me that many myeloma specialists are beginning to advocate hitting multiple myeloma upfront and hard. That’s what TT does. There does seem to be some disagreement over whether tandem transplants are necessary. However, employing them is consistent with a mission focused on knocking out myeloma early, before it can morph and evolve into multiclonal, drug resistant disease.
Are some patients that undergo Total Therapy cured? Possibly. But how many? Certainly not 50%. 10%? 20%? Your guess is as good as mine. But keep in mind that otherwise healthy, low risk patients are likely to live longer regardless of the therapy. Mayo Clinic just completed a retrospective study, looking back at low risk patients that had been treated there using incremental therapy. The median life expectancy was also ten years. I don’t believe the study tried to identify a cure rate; Mayo Clinic specialists still consider multiple myeloma incurable for all but a few “outliers.”
I believe this ongoing debate is a healthy one. While we may not agree about how many patients TT cures, Nick and I do agree that the option of being treated aggressively should be offered to younger, low risk patients regardless of where they’re treated.