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New Advances Bring Hope to People with Myeloma

by Peter West

“The good news is that we are learning more and more about myeloma,” says Robert Z. Orlowski, MS, PhD, a noted blood cancer expert at Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, during an educational workshop sponsored by The Leukemia & Lymphoma Society. “Our treatments are becoming more effective.”

 

Myeloma: The Basics
Scientists do not know the cause(s) of myeloma, which strikes nearly 20,000 Americans annually. The malignancy forms masses of plasma cells, destroying normal bone tissue, causing pain, and crowding out normal blood cell production. With their weakened immune systems, people with myeloma are susceptible to infections and other secondary complications.

Skeletal pain is a common early symptom. Most people with myeloma who experience this symptom feel soreness in the back or the ribs, but pain and fracturing can occur in any bone. It is usually made worse by normal movements like walking, lifting, and even coughing.

Myeloma remains the most difficult blood cancer to cure, with just a 34 percent relative, five-year survival rate in the United States. The cancer occurs more often in men than in women, with the median age of diagnosis at 70 years of age. No one knows for sure why, but African-Americans appear more prone to getting myeloma than other racial and ethnic groups in the United States. In fact, African-Americans have more than double the incidence (11.2/100,000 population) than Caucasian- Americans (5.1/100,000), according to Surveillance, Epidemiology, and End Results data from the National Cancer Institute.

Treatments: Promising New Therapies
Chemotherapy has been the mainstay of treatment for years. But achieving complete remission for long periods is a challenge. Conventional chemotherapy with one, two, or three drugs has therefore given way to treatment that is more intensive, using new agents and in different combinations. These new drugs include Velcade®, a proteasome inhibitor, and Revlimid®, an immune modulator.

For people who can withstand high doses of pre-treatment chemotherapy and/or radiation, stem cell transplants, usually with a person’s own stem cells, are a recommended therapy. The good news is that transplant physicians are developing less strenuous pre-transplant conditioning regimens that may be suitable for a wider range of people in the future.

“Right now, the challenge that we face sometimes is having so many and different alternatives that we don’t know exactly what the sequence of these [treatments] should be and what should we offer first to patients,” says Melissa Alsina, MD, an associate professor and myeloma expert at the H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, during an LLS educational program. “But studies are ongoing right now to try to solve those dilemmas.”

Looking Ahead: The Future of Myeloma Brings Hope
There is every reason to believe that new and better treatments for myeloma will appear in the near future. Scientists are investigating a range of intriguing therapies, such as immunotherapy, statins (normally used to lower high cholesterol), targeted radiotherapy, and antisense oligodeoxynucleotides. While the future of myeloma research is promising, success will ultimately depend on the vibrancy of clinical trials and their ability to attract enough participants. Clinical trials are the proving ground for innovative therapies, but not enough people, especially seniors, are enrolling.

“We’re moving in the right direction, and I believe that patients should feel hopeful,” says Deborah Banker, PhD, vice president, Research Communications, LLS.

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