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High-Risk Myeloma Treatment

Multiple myeloma---MM---is a cancer of a type of white blood cell called a plasma B cell. Ordinarily, plasma cells produce antibodies. In MM patients, however, cancerous plasma cells proliferate out of control and infiltrate bones and other organs. Although treatment achieves remission in some cases, 90 percent of people diagnosed with MM die within two years. Research continues toward the objective of finding more effective treatments.

  1. Risk Stratification

    • Genetic changes that take place in some MM cancer cells are strongly associated with a poorer prognosis. The changes seem to make the cancer more aggressive. Patients whose cancer cells exhibit these genetic markers are commonly classified as high-risk patients. Doctors often prescribe more aggressive treatment for high-risk cases. There is some debate among physicians and researchers over which genetic markers are most important in defining the high-risk category and the usefulness of the classification, but as of 2010 it is still widely accepted.

    Bortezomib and Chemotherapy

    • Chemotherapy is the most common treatment for high-risk MM. Bortezomib is one commonly administered drug. It works by inhibiting the activity of the proteasome, a structure in cells that breaks down proteins that are damaged or that the cell no longer needs. Cancer cells appear to be more susceptible to this approach than healthy cells. Bortezomib is often administered in along with other drugs as part of a combination chemotherapy regimen. Thalidomide, prednisone and melphalan are other common drugs used to treat multiple myeloma.

    Stem Cell Transplant

    • Hematopoietic stem cell transplantation---or HSCT, also known as bone-marrow transplant---is sometimes an option for high-risk patients. During HSCT, physicians use several rounds of chemotherapy to destroy cancer cells then repopulate the bone marrow, either with healthy stem cells transplanted from a donor or using stem cells from the patient harvested and stored prior to the procedure. HSCT carries the risk of a number of serious complications, so it's not appropriate for all multiple myeloma patients.

    Novel Therapies

    • For patients with high-risk MM, doctors may recommend novel therapies as part of ongoing clinical trials. Since patients in the high-risk category may have less chance of survival than standard-risk patients, taking part in a clinical trial for a new therapy may sometimes offer high-risk patients their best shot at successful treatment.

    Considerations

    • High-risk myeloma can quickly induce a number of complications. As the proliferating cancer cells invade bones and other organs, they can cause bone pain, collapse of the vertebrae in the spine, kidney failure or other serious problems. Physicians treat these effects of the disease as well as the disease itself.
      Living with MM is a difficult experience. It's often helpful to join a support group through which you may meet others who face the same challenges and understand what you're going through.

    Speak with Your Physician

    • Nothing in this article is intended as medical advice. If you have questions or concerns about your treatment, the best person to consult is your doctor.

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