Recent news about the health of the distinguished journalist, Tom Brokaw, has focused attention on multiple myeloma, a malignant disease of the bone marrow. Myeloma is characterized by an uncontrolled growth of marrow plasma cells, which normally produce antibodies for our immune system. In its advanced stages, the overgrowth of these cells and their associated proteins can cause anemia, painful bone destruction, and kidney failure.
Until about 10 years ago, advanced myeloma was uniformly fatal with a typical survival of about 3 years. Recent years, however, have seen a remarkable improvement in treatment possibilities for myeloma. This began with the discovery that autologous stem cell transplantation could produce complete remissions and longer survival. In addition, a variety of chemotherapy drugs administered in combination with corticosteroid drugs, now produce responses in up to 80% of patients. This means about 80% of patients are surviving longer than 3 years after chemotherapy and autologous stem cell transplant.
Not all patients with myeloma require chemotherapy. Myeloma can exist in an early stage for years. This is called smoldering myeloma. Chromosome analysis is routinely done on myeloma cells and allows us to identify patients with more aggressive forms of the disease, and those requiring treatment due to signs of organ damage or bone pain.
The Swedish Cancer Institute has been a participant in clinical trials leading to the development of some of the effective new treatments for myeloma. We are currently participating in a study of pomalidomide, a newly approved agent, for patients with relapsed myeloma. Another study offers an investigational drug, MLN9708, for newly diagnosed patients.
While the new drugs are more effective and better tolerated than previous chemotherapy, all have possible side effects. One of the challenging side effects of drugs such as thalidomide and bortezomib is neuropathy, or numbness of the fingers and toes. Dr. Dan Labriola, a naturopath working with the Swedish Cancer Institute oncologists, has recently opened a clinical trial of L-glutamine and vitamin B6 given along with bortezomib to prevent peripheral neuropathy.
In summary, this is a very exciting time in the field of myeloma treatment. We are seeing the emergence of new targeted treatments and improved survival and quality of life. You can learn more about myeloma through the Multiple Myeloma Research Foundation.