Multiple myeloma is a chronic, incurable, blood-based disease that afflicts almost 1 in 100 American adults. The United States, with about 15,000 new myeloma cases per year, is among the highest incidence nations in the world, with five times the annual incidence compared to France.
In myeloma, bone lesions such as pain, tenderness, bruising, swelling and pain in the jaw of the jaw can be present early. This can lead to poor wound healing with increased risk of infection. The bone lesions may be absent on imaging but can be a sign if painful bone lesions such as osteomalacia, osteonecrosis and osteomyelitis are present. This is of key importance because the pain of bone lesions can potentially be misinterpreted as acute myelogenous leukemia. Tumor markers, such as bone marrow trephines or the urine β2 microglobulin level, help in staging myeloma, but do not help in detecting acute leukemia.
Current therapies can be effective at removing multiple myeloma from a person's circulation yet, unfortunately, even if the cells are completely removed, they do not usually go away. Further study is required to determine the nature of these cells and how they can be effectively removed using chemotherapy.
There are a myriad of treatments designed to treat multiple myeloma including medications, chemotherapy and bone marrow transplantations. Generally, these treatments are targeted towards preventing disease progression and delaying the progression of the disease. Because of the number of treatment modalities available multiple myeloma treatment should be tailored to the individual needs of a patient based on their physical and emotional state, as dictated by their disease's staging and the extent of their disease and should be adjusted as treatment improves the effectiveness and quality of life. Once a patient has an effective response to their initial therapy, they do not require more intensive therapies. However, because they continue to have a high risk of relapse and mortality and therefore require an ongoing chemotherapy or biologic treatment program.
Myeloma is a non-lymphoid cancer that results from the abnormal division of plasma cells. The development of an myeloma is multifactorial, with both hedonistic and familial factors influencing overall survival. Early detection, especially in men with myeloma, in combination with effective therapeutic regimens, can improve treatment efficacy. The use of biological and clinical markers such as VAD or PAD might help to improve the ability to predict survival in multiple myeloma.
This survey confirms that multiple myeloma remains an elusive disease with an average survival rate of 4.5 years. There has been a recent significant increase in the number of patients with this disease in the United States. Because multiple myeloma affects 5-7% of the global population, these results are not particularly significant. Nevertheless, the increase in multiple myeloma cases is not seen in every country, and there are different time trends in the United States and other countries. It is important to know that in addition to better treatment of multiple myeloma, there is no cure for this disease. Physicians must remain on an alertness to search for early diagnosis, early treatment, and appropriate management whenever possible.
This initial genetic study indicates that myeloma incidence and disease incidence are not related. Because of the limited number of patients evaluated, it is not clear if we can attribute a predisposition to development of cancer due to a single or common genetic susceptibility factor. In contrast, for B-cell lymphoma, a common genetic susceptibility factor is an initial event that contributes to disease development, leading to a second, post-syndromic event.
Among those with active MM, QoL improved, despite greater rate of progression, despite pembrolizumab and a higher rate of DLTs with pembrolizumab compared with placebo.
Although pembrolizumab is the only FDA-approved therapy for patients with multiple myeloma, some patients do not have clinical benefit. The development and implementation of new therapy will be influenced by the advancement of genomic testing that enables a careful management of patients who are identified as being in need of therapy. We discuss what type of data should be collected to enable patient selection for treatments that are best for patients. Furthermore, we discuss how to optimize treatment, and whether patients who do not benefit from treatment could receive it.
Several small cohort studies on the effectiveness of pembrolizumab in patients with multiple myeloma have been conducted, but none of them has reported significant superiority against other drugs. Therefore, clinical trials need to be conducted on the most effective drug for a personalized approach.
This preliminary analysis indicates the clinical usefulness of pembrolizumab combined with VD+CTR, VD+PTK and VD+RT. However, the findings should be verified in larger studies before being used in routine clinical practice.