According to a story from ASH Clinical News, the treatment of younger patients with multiple myeloma, a form of rare blood cancer, requires physicians to take into account certain factors that require different approaches to treatment from older patients. Multiple myeloma is generally a disease of the elderly with a median age at diagnosis of 70. However, around 37 percent of patients are 65 or younger.
About Multiple Myeloma
Multiple myeloma, which is occasionally referred to as plasma cell myeloma, is a blood cancer that affects plasma cells. These are white blood cells that produce antibodies. The overall cause of multiple myeloma is not well understood, however, some risk factors have been identified. These include obesity, family history, smoldering myeloma, and monoclonal gammopathy of undetermined significance. These last two conditions have the potential to develop into multiple myeloma. Symptoms of this cancer include bone pain, infections, anemia, kidney failure, overly thick blood, confusion, fatigue, headaches, and amyloidosis. Treatment includes chemo, stem cell transplant, and other medications for relapsed disease, which is common. Five year survival rate is 49 percent in the US. To learn more about multiple myeloma, click here.
Getting Started and Other Considerations
For younger patients diagnosed with active disease, treatment is recommended to begin immediately. In addition, physicians should also recommend that younger patients seek out opportunities for treatment in clinical trials. There are several different regimens that doctors should consider but to determine which is best it is a good idea to consider other factors such as comorbidities, or other health problems that affect the patient. The consideration of these comorbidities is important in order to minimize the risk of adverse effects from treatment.
For patients without comorbidities, a chemotherapy regimen called RVD (lenalidomide, bortezomib, and dexamethasone) is a common approach that can be conducted for six to eight cycles. Autologous hematopoietic cell transplant (AHCT) may also be an option. Another similar chemo regimen is called KRD (lenalidomide, carfilzomib, and dexamethasone) is another choice; however, this approach is best for patients that present with peripheral neuropathy. Some patients may also present with renal impairment as a comorbidity. In these cases a combination of cyclophosphamide, bortezomib, and dexamethasone (CyBorD) is considered best.
The role of AHCT is still a subject of debate. It can be effective for many patients but it comes with greater risk of serious side effects. It is possible that other approaches can be comparable in effectiveness without the same risks. Continuous therapy with lenalidomide is recommended following induction. Ongoing research into new approaches could quickly change how multiple myeloma is treated in younger patients.