Multiple Myeloma Yields To Newer Therapy
Many tears ago when I was teaching residents and fellows at Manhattan's Lennox Hill Hospital there wasn't much new to teach. We had old medications including Cytoxan and other cytoxan-like medications and prednisone or dexamethasone (decadron). If patients relapsed from this therapy they were offered an autologous bone marrow transplantation after receiving very high doses of similar medications or high-doses of the old therapies without transplant. It took several years to appreciate that the transplants actually extended the survival for many patients eligible to receive such therapy. Survivability from transplantation rapidly increased when done at the transplant centers. The procedure was initiated at M.D. Anderson hospital in Houston and subsequently fame came to the state of Arkansas which rapidly became the myeloma transplant center for the USA.
Now, as indicated in the accompanying schema above we have several new and very effective myeloma therapies including immunotherapies and many experts are discussing possible cure with many patients.
One very significant problem when you have several different and effective therapies is how to combine them safely and most effectively. That is where we are now. We have increased survival at 6 years to almost 80% for Stage I patients and 40% for Stage III advanced disease. These numbers were only 1/3rd as much in the 1970's. We are making good progress here as we change treatment paradigms. Aside from new medications and effective CAR T-cell immunotherapy, use of maintenance therapies with decadron (dexamethasone) and Revlimid (lenalidomide) after initial induction therapy have made use of the more aggressive therapy of autologous bone marrow transplantation a more distant option.
Glenn Tisman, M.D.
Comments