Can you go into remission of multiple myeloma without a stem cell transplant with just chemo drugs?
Determining the stage and specific risk factors in multiple myeloma can help predict people’s response to treatment and help doctors figure out the most effective way to treat patients with multiple myeloma. Bone marrow transplants are a common approach to treatment for multiple myeloma, but new approaches do offer alternatives.
First, a bit of background on this particular type of cancer. Multiple myeloma is a type of cancer that comes from the excessive growth of a specific type of immune cell called a “plasma cell.” Normally, we have many different plasma cells in our body that make all different types of immunoglobulins to fight different types of infections. In a patient with multiple myeloma, one of these plasma cells keeps making clones of itself so that only a single immunoglobulin protein is made. These single plasma cells keep dividing over and over again, often inside the bone marrow where they are produced. These cells make so many copies, or clones, of themselves that they begin to push on the inside of the bone and cause skeleton destruction and fractures. Sometimes this bone pain will be the first clue that a patient has multiple myeloma. Other symptoms in multiple myeloma include kidney problems, extra calcium in the blood, and even low red blood cell counts (anemia). Another common problem includes infections because the plasma cells are only making one type of immunoglobulin and the body then has trouble fighting lots of different types of infections. These multiple copies of plasma cells often will stick to each other in the blood in long lines of cells that look like coins stacked in a row.
This type of cancer often happens in older patients but also has been described in people ranging in age from 20 to 92 years old. (Less than 2 percent of patients with multiple myeloma are younger than 40 years old, to give you an idea of how rare it is in young adults.) Multiple myeloma will act very differently among different people. Some patients will not respond to any therapy at all, while other people do so well that they do not need any treatment for many years.
There are many different ways to treat multiple myeloma, and some doctors may suggest bone marrow transplant, while other doctors prefer to try chemotherapy at first. If the doctor recommends transplant, it is usually an autologous bone marrow transplant, which means the patient provides his or her own stem cells for the transplant procedure. Ultimately, most patients with multiple myeloma will eventually require a bone marrow transplant. If a patient has aggressive multiple myeloma and is not a candidate for transplant (because of their age or other health problems), then this situation used to have a very poor prognosis. However, with new combination of drugs such as melphalan, thalidomide, lenalidomide, and/or bortezomib, the outlook for patients with multiple myeloma is improving tremendously. When these new therapies are combined with other types of drugs, like the steroid dexamethasone, patients with multiple myeloma have lived at least two years longer than previously. New clinical trials demonstrate that chemotherapy alone can induce sustained remission for long periods of time in specific patients. As more research and clinical trials are performed, we expect the survival of patients with multiple myeloma to continue to improve.
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