Most of the signs of [multiple myeloma](https://www.withpower.com/clinical-trials/multiple-myeloma) appear before 20 years of age, while those of light chains myeloma most often appear later. Some of the signs of multiple myeloma appeared early in our patients, indicating that the disease is not as rare as is usually reported. The role of imaging in the diagnostic of multiple myeloma is not yet fully understood, but there are signs of disease in MRI, especially Bence Jones proteinemia and a lytic lesion on skeletal radiography. However, the role of imaging for multiple myeloma in symptomatic disease is much more challenging, with no definitive conclusions.
The primary cause of multiple myeloma is a combination of genetic abnormalities and environmental exposures. Genetic changes appear early in the course of the disease and may also play a role in the development of multiple myeloma. Many genetic changes are not known, but when they are found, they tend to appear early in the disease. Environmental exposures that worsen multiple myeloma are the primary risk factor, but genetic alterations must interact with environmental factors to develop multiple myeloma. The risk factors and the timing of development of multiple myeloma remains unknown.
Patients treated with a highly standardized plan of care and who attained a nadir of <5 g/dL had no evidence of progression at 3 years. However, survival was better when compared to patients treated with more conventional regimens.
A wide variety of treatments are used to treat patients with multiple myeloma. Common options include high-dose alkylation and stem cell [transplant](https://www.withpower.com/clinical-trials/transplant)ation; thalidomide, lenalidomide, autologous stem cell transplantation, chemotherapy, autologous stem cell transplantation, immunotherapy, and radiation therapy; allogeneic stem cell transplantation, bone marrow transplantation, high-dose chemotherapy, stem cell transplantation, and chemoimmunotherapy; and targeted therapies, such as protease inhibitors, receptor tyrosine kinase inhibitors, or immunomodulators. Because of the high mortality of patients with multiple myeloma, ongoing research has been aimed at a deeper understanding of the disease.
MM is a type of cancer in which the bone marrow is invaded and cloned by abnormal plasma cells. MM is more common in older, heavier individuals, is associated with high levels of light chains, and tends to recur more often and progress more rapidly. While the disease is treatable, a cure has not been found. This myeloma is not the same disease, however, that is mentioned in the title of the book. The name is a reference to the multiple occurrences of the same cancer in the body.
5% of both men and women in the USA were diagnosed with this disease in 2012; this translates to about 37.6 new cases per million each year. Although multiple myeloma has the highest survival of all hematologic malignancies, about one third of people are diagnosed at a stage where treatment is not possible.
Data from a recent study of our study demonstrate a significant differences in DFS and OS of MM patients. The prognosis varies between the patients with the presence or absence of SPn or SPn+LN and the DFS values are higher in both groups in comparison to the patients with the absence of LN.
This is an important development as it is likely to provide the first evidence of the real-world use of newer agents, as reflected in the FDA review of the therapeutic use of Rituximab. The impact of such new drug developments will be the subject of a further article.
The association of multiple myeloma with a known causal gene suggests that a genetic predisposition may be an important factor in the etiology of multiple myeloma. A genetic basis for multiple myeloma should be recognized in future translational studies.
In the long run, HRQoL for this group improved and those who completed induction and discontinuation achieved HRQoL that was equal to, or superior to, that of the general population. This suggests that clinicians might be able to reduce treatment burden and, as a result, the risk of toxicity.
In our experience, CBT (the discontinuation regimen used in the MMM2016 trial, as well as in the earlier trials used to establish CBT's efficacy, e.g. CALGB 80303 and CALGB 006) is beneficial in MMM patients.
No cures have been found for multiple myeloma, but recent therapies have improved survival rates and prevented further bone destruction. Current standard treatment regimens often produce disease stabilization or even remission as well as a very good response to treatment in most people with multiple myeloma. Further improvements can come from discovering new therapeutic regimens and using treatment strategies that can extend OS and minimize cumulative toxicities. Future research may also benefit from better understanding the molecular pathways that define response and treatment outcome and the development of new drugs to target these pathways. Today there are many researchers involved in multiple myeloma research, but unfortunately advances in the treatment and understanding of the disease have been slow to emerge.