Decisions, Decisions...

Tomorrow we meet with Dr. Richardson and the rest of my medical team.  The question about my participating in the ASCT clinical trial (BMT CTN 0702) will be front and center.  I have been allowing this issue to fester in the back of my mind for the past several weeks rather than trying to analyze the shit out of it.  Now it's time to, well, start analyzing the shit out of it.

I'm starting with a few assumptions:

• I should continue with the current MLN9708 protocol as long as I continue to improve each cycle, delaying any transplant until I reach a maximum response (hopefully CR or sCR).
• I will still be eligible to participate in the ASCT clinical trial after such a delay.
• Insurance will cover the expenses of collecting my stem cells even if I don't use them immediately.

Aside from the MM, I am in good health right now, in that my liver, kidneys, heart, and lungs are all functioning within or close to their normal ranges.  This is an important consideration for doing a stem cell transplant.  If I delay ASCT until my first relapse (hopefully several years downstream), I will be in my seventies, and who knows what my health level will be then?  As one ages, renal function declines, and frailty, weight loss, and decreased ability to tolerate toxicity become factors.

Normally, enough stem cells are collected to perform two transplants.  If I elect to have a transplant in the near future, I still may be eligible for a second ASCT downstream.  However, if I delay the first one until after relapse, I will likely only be eligible for a single transplant due to age and/or health considerations.  This could take one of my options off the table.  It may be advantageous to have both novel drug regimens and two transplants available to me as therapy choices.

While there is a lot of research underway now to examine the efficacy of delaying ASCT until first relapse, not enough data is available yet to validate this approach.  As I mentioned in a previous post, there are some doctors who feel that until more new and effective drug therapies become available 5 or 10 years from now, the current approach of doing ASCT early is still the best therapy option.

This exercise is to get my thoughts together a bit before meeting with Richardson tomorrow.  In the end, I will most likely follow the course he recommends.  However, I want to be comfortable enough with the various options to have a complete buy in to the path selected.

I am not looking forward to undergoing this ASCT procedure any time soon.  It almost seems contradictory for me to be feeling really good and then make a decision to undergo a risky procedure that will make me feel really bad for a while.  However, at this point I'm thinking that I probably should do this.