I have to say I disagree with the Spanish doctor regarding therapy induction and ASCT for newly-diagnosed patients having a better overall outcome versus therapy alone. I have had a CR for over 3 years with therapy alone (thank God) and have not had a SCT yet. Another patient in my oncology group had the same response but begged his doctor for a transplant. He had one and is now doing very poorly. Yet more proof for individualized treatment. I'm just thankful we have choices!
Dr. San Miguel's comments at the Friday evening ASH meeting were based, of course, on statistics from large numbers of patients in clinical trials, and on new techniques for measuring minimal residual disease even in patients who have achieved complete response--"CR"--by conventional testing. Statistics don't tell us about individual patients, but they do tell us about patterns of response and survival in large groups. For the past several years, we really haven't known if there is any benefit to doing a transplant if you've achieved CR with up-front novel therapy. Now evidence is mounting that CR is not the same for every patient, and that novel therapies + transplant = longer remission and overall survival. That certainly doesn't mean that EVERY patient should follow that dictum. Individualized treatment is still key, BUT data from clinical trials is what drives best clinical practice, and we're beginning to see longer-term survival data in those patients who have consolidated the gains made with novel therapy by doing a stem cell transplant soon after. Again, since this is information based on patterns in large numbers of patients, it doesn't predict what will happen for any individual patient. It's good to hear that you're doing so well and that you and your doctor chose therapy that was best for you.