Not everybody who gets multiple myeloma has the same risk. When patients are diagnosed with multiple myeloma, they are almost immediately split into one of two groups based on how dangerous their myeloma is: standard risk and high risk.
Standard risk has “a better prognosis” whereas high risk myeloma “confers a much poorer outcome,” according to Dr. Kenneth Anderson, Director of the Jerome Lipper Multiple Myeloma Center at Dana Farber Cancer Institute. So when it comes to treatment, in the first two phases there is no difference. But the treatment approach differs in the third phase. Here’s how it works.
- Induction Phase: This phase is the same regardless of risk. It consists of a triplet drug therapy
- Stem-Cell Transplant Phase: This phase is the same regardless of risk. It consists of chemotherapy coupled with a stem-cell transplant.
- Maintenance Phase: This phase will differ based on the risk-profile.
Read More During this maintenance phase standard risk patients are usually given only
Revlimid (lenalidomide), a drug that acts on the immune system, daily for three weeks. In contrast, high risk patients are given
Revlimid (
lenalidomide) daily for three weeks in addition to a proteasome inhibitor, like
Velcade (
bortezomib), every other week. This drugs blocks cancer cells ability to process essential proteins. In short, the standard risk patients need one drug while the high-risk patients need two. According to Dr. Anderson,
lenalidomide has been shown to extend overall survival in the standard risk patients, and halt progression of the disease for two times as long as not taking the drug. But he says, “A proteasome inhibitor needs to be added in with the
lenalidomide in the high risk patients in order to achieve that benefit.” Anderson explains that recent advances in myeloma medicine have made it difficult to give a concrete sense of how long patients survive on the treatment, because it's constantly improving. "I think it's hard to precisely tell you the life expectancy now…there's been so many advances," says Anderson, "We know that the progression-free survival, the time without active myeloma, is at least three to four times what it was a decade ago."
At the very least, maintenance therapy is an essential part of treatment for all patients. "What can we say is at ten years, patients are living at least a year or two longer with maintenance than they would have if they didn't have maintenance."
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Dr. Kenneth Anderson is the Director of the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute. Read More
