Multiple myeloma is an exceptional cancer in terms of its prognosis. A recent study from Statistics Canada showed that patients who survive their first five years with multiple myeloma have only a 60 percent chance of surviving an additional five years.
Larry F. Ellison and colleagues collected statistics on 26 cancer types, and calculated the relative survival rates (relative to a similar population without cancer) at the time of diagnosis, and at survival times up to five years. Multiple myeloma ranked 19 out of the 26 cancer types in survival rates at the time of diagnosis, but it fell to last place at the five year mark.
The disappointing prognosis for long-term survivors represents a treatment challenge.
The U. S. National Library of Medicine's PubMed Health web site provides an overview of multiple myeloma. It is a cancer of the plasma cells in the bone marrow, which are a vital part of the immune system.
Other names for this condition are plasma cell dyscrasia, plasma cell myeloma, multiple plasmacytoma, and plasmacytoma of bone. Treatment options currently available include drugs, radiation, and bone marrow transplants.
Progress in treatment was reviewed by Dr. David Dingli and Dr. S. Vincent Rajkumar of the Mayo Clinic, Rochester, Minnesota. “The last decade has seen a renaissance in our understanding of multiple myeloma (MM) biology,” Dingli and Rajkumar wrote. This understanding has led to the development of novel therapies including immunomodulatory drugs and proteasome inhibitors (bortezomib, brand name Velcade).
Treatment starts with risk stratification, according to the Mayo Clinic authors. Physicians should evaluate which patients are candidates for autologous stem cell transplants, using their own bone marrow, and which patients are at high risk for disease progression. In the United States, patients up to 75 years of age may be candidates for autologous stem cell transplants.
For patients who are candidates for autologous stem cell (bone marrow) transplants, treatment starts with induction drugs. Regimens include thalidomide, lenalidomide (a thalidomide derivative), bortezomib, and combinations. After the transplant, patients may achieve remission for a considerable time, but maintenance drug therapy is usually required.
Bone marrow transplants from another person are used in some patients, but these carry serious risks, according to the PubMed Health site. Dingli and Rajkumar explained that more aggressive drug therapy can be used for patients who are not candidates for either type of bone marrow transplant.
“Hopefully, the impressive response rates being reported are durable and will translate into meaningful and long term improvement in survival if not yet cure,” Dingle and Rajkumar concluded.
References:
1. Ellison LF et al, “Conditional survival analyses across cancer sites”, Health Reports 2011 June; 22(2): 21-5.
http://www.ncbi.nlm.nih.gov/pubmed/21848129
2. U. S. National Library of Medicine. PubMed Health. Web. Nov. 1, 2011.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001609/
3. Dingli D et al, “How best to use new therapies in multiple myeloma”, Blood rev. 2010 May; 24(3): 91 – 100.
http://www.ncbi.nlm.nih.gov/pubmed/20359801
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
Reviewed November 9, 2011
by Michele Blacksberg RN
Edited by Jody Smith