An unusually intensive assault on the cancer multiple myeloma, using two rounds of high-dose chemotherapy followed each time by a stem cell transplant, appears to double patients' long-term chances of survival, a study found.
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Although the approach is not a cure, doctors say the results are encouraging for victims of this usually lethal cancer of the bone marrow.
The researchers found that after seven years, 42 percent of patients who got the double treatment were still alive, compared with 21 percent of those who received the standard single round of chemo plus a transplant.
The head of a U.S. marrow transplant program said the French study is another important development in what has been an exciting year for multiple myeloma research, including federal approval in May of the drug Velcade, which targets one of the underlying defects that make this cancer grow.
If such developments continue, "I'm very optimistic that we will be thinking of this as a curable disease within my professional career," said Dr. Edward Stadtmauer of the University of Pennsylvania's Abramson Cancer Center.
Stem cell transplants: Expensive, dangerous
A transplant allows a higher dose of chemotherapy, because it puts the patient's stem cells back into the body to replace those killed by the treatment. Stem cells are a crucial component of bone marrow, which produces blood cells.
The study, led by Dr. Michel Attal of Purpan Hospital in Toulouse and published in Thursday's New England Journal of Medicine, looked at 199 patients who got two rounds of treatment, and 200 who got a single set.
In addition to increasing life span, the second round of treatment doubled the chance of surviving seven years without a recurrence of cancer (20 percent versus 10 percent).
The difference was most striking for people who had not had a good response to the first transplant. Only 11 percent of those patients lived seven years without a second transplant. With a second transplant, 43 percent survived that long.
Stem-cell transplants are expensive -- a single round can cost $150,000, about triple the cost of standard chemotherapy -- and dangerous: Five people in each group died from the transplant itself.
"It may be that patients who are not doing well after a first transplant should automatically go in for a second transplant. That may be the most important lesson to get from that study," said Len Lichtenfeld, deputy chief medical officer of the Atlanta-based American Cancer Society.
Multiple myeloma is described both as a bone cancer and a blood cancer. It affects the plasma cells that make infection-fighting antibodies.
Instead of making antibodies against a wide variety of diseases, the cells begin overproducing one and making too little of others. That leaves patients anemic, open to infections and susceptible to bleeding. Bones become painful and brittle. Other proteins interfere with kidney function.
A half-century ago, diagnosis meant almost certain and swift death. Now, treatment can help many patients at least feel better for a while and fight off infections, keeping them alive for years and even decades.
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