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1990 and 2016 . This trend might be explained by the fact that people are living longer , because the risk of myeloma increases with age and is most often diagnosed in people over age 60 . It ’ s also more prevalent in black people than it is in white people , and it ’ s slightly more common in men than it is in women . Of course , not everyone who gets the disease fits the mould : Chmielewski , a white woman , was diagnosed in her 40s .
3 . It is possible to have a precursor condition that might not require treatment . Some people , like Chmielewski , are diagnosed with full-blown myeloma that meets the CRAB criteria . But because the disease may be preceded by two precursor states , others may learn at an earlier stage — usually through routine bloodwork , since these precursor stages aren ’ t accompanied by symptoms .
The earlier precursor state is MGUS , which stands for Monoclonal Gammopathy of Undetermined Significance . Only one per cent progress to multiple myeloma .“ Most of them can be closely monitored and will hopefully never need treatment ,” says Dr Schecter .
The other precursor state , called smoldering multiple myeloma , is more of a middle ground , he explains .“ It ’ s an asymptomatic form of myeloma that doesn ’ t meet the CRAB criteria , and the standard of care is to not treat those patients but rather just closely monitor them .” However , about 15 per cent of people with smouldering multiple myeloma will progress to multiple myeloma within three years .
For that reason , scientists are working to identify who is at highest risk of progressing . Clinical trials designed to find out which smouldering multiple myeloma patients may benefit from earlier treatment are currently underway .“ The standard of care is evolving ,” says Dr
4 Schecter . . Multiple myeloma is rarely treated with surgery , and drug regimens are often adjusted Because multiple myeloma is a blood cancer rather than a solid tumor , it ’ s rarely treated with surgery . Instead , patients receive induction therapy comprised of medications administered both orally and subcutaneously ( under the skin ), which are designed to induce remission .
The current mainstays of treatment come from three main classes of drugs , explains Dr Schecter : IMiDs , or
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immunomodulatory drugs , which have direct activity against the plasma cells and also harness the power of the body ’ s immune system ; proteasome inhibitors , which can help kill myeloma cells ; and CD38 antibodies , which bind to a protein on myeloma cells .
This induction therapy is often followed by an autologous stem cell transplant — a procedure in which the patient ’ s own bone marrow stem cells are removed from the blood and infused after a high dose of chemotherapy is used to kill off cancerous stem cells in the bone marrow . However , many patients are too old or frail to undergo a stem cell transplant .
When stem cell transplants fail or the disease progresses despite a transplant , oncologists generally turn back to drugs in these three classes , using either different drugs or combinations , as patients will need to change their drugs or regimen if their current one stops working . However , patients typically are not cured and relapse — pointing to the need for more therapeutic options .
5 . There ’ s no cure for the large majority of patients , but people now have more treatment options - and hope When Chmielewski was first diagnosed , there were only a few myeloma drugs on
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A close-up view of antibodies |
the market . Fortunately , these treatments did put her into long-term remission . “ If those had stopped working for me , there would have been nothing else available ” outside of a clinical trial , she says .
Now , when someone relapses , there are multiple combinations of approved drugs that patients could try , some of which Janssen has developed , says Blake Bartlett , Ph . D ., head of Multiple Myeloma & Plasma Cell Disorders , Global Medical Affairs , Janssen . The current options include drugs with a variety of mechanisms of action in at least five separate drug classes .
As myeloma treatments are advancing , people have more hope in managing the disease . “ About 20 years ago , the life expectancy was about three years , and overall , now it is at least five to six years ,” says Bartlett .
Although long-term data on the latest therapies and updated drug regimens is not yet available , patients with standard risk features who incorporate newer options , including some of the latest immunotherapies , may now expect to live more than five or six years with the disease , he adds .
“ My daughter was 19 when I was diagnosed , and now we ’ re going dress shopping for her wedding next year ,” says Chmielewski . “ When I was newly diagnosed , I never thought I ’ d be around to see her get married .” She is still faring well on older drugs she ’ s been taking for many years , but knowing that other options are out there “ gives me so much hope , because I don ’ t have to worry as much if I relapse someday .”
As research in this area continues to advance , so does hope . A potential cure might even be on the horizon , perhaps by treating patients earlier with different combinations or sequences of existing or developing therapies that are being investigated in clinical trials .
“ We ’ re focused on developing first-inclass or best-in class therapies and really aim to change the treatment landscape ,” says Bartlett . “ We ’ re also conducting clinical studies to determine the best way to integrate our new generation of therapies into the standard of care , which might someday help us deliver cures for most patients .” – The Health
This article appeared recently on the website of Johnson & Johnson
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