When it comes to various types of cancers, most people readily recognize the most common ones. Breast, lung, ovarian, colon, and prostate cancers are certainly well-publicized. Likewise, it’s not uncommon to hear about someone struggling with pancreatic, liver, or even brain-related cancers. But malignancies affecting the blood system are less well understood, especially when they have funny names like multiple myeloma. But blood cancers account for a tenth of all malignancies, and multiple myeloma represents a tenth of these. Thus, it’s important to appreciate multiple myeloma prognosis and advances in multiple myeloma treatment.
In the past, multiple myeloma prognosis was not that great. In fact, not long ago, the average lifespan after diagnosis was about three years. But this has since changed with major advances in multiple myeloma treatment over the last two decades. Some of these new treatment discoveries came from extended research trials involving older chemotherapy drugs. But more recent findings have occurred as a result of precision medicine that individualizes care for patients. As a result, patients with multiple myeloma are not uncommonly living 15 years or more after diagnosis. And for those diagnosed today, the promise of a cure during their lifetime is a real possibility.
“Thirty years ago, multiple myeloma was a death sentence. Today it’s one of the most treatable cancers out there.” – Kathy Giusti, Founder of the Multiple Myeloma Research Foundation
What Is Multiple Myeloma?
In order to appreciate what multiple myeloma is, it’s necessary to understand the cells from which it develops. There are numerous cells in the body’s bone marrow that develop into different blood cells. Some are white cells involved in fighting infections and cancers. Some are red cells that contain hemoglobin and help oxygenate tissues. And others are platelets, which play a role in blood clotting. Multiple myeloma cancers develop from a special type of white cells called plasma cells. Plasma cells are the ones that produce antibodies that help use fight infections. But in the case of multiple myeloma, plasma cells proliferate excessively at the expense of all other blood cells. And ultimately, this rapid growth is what triggers a poor multiple myeloma prognosis.
It should be recognized that multiple myeloma is not a young person’s cancer. In fact, it’s quite rare before the age of 45 years. The median age of diagnosis is nearly 70 years of age. In addition, it does tend to be more common in men and among African Americans. Multiple myeloma may also go unrecognized for some time and be asymptomatic. But once symptoms appear, they tend to relate to bone marrow effects caused by the aberrant plasma cells. As plasma cells increase, other blood cells diminish. This can cause anemia, increased risk of infection, and extreme fatigue. Also, bone destruction by the plasma cells can trigger bone pain, increased blood levels of calcium, and even bone fractures. And sometimes plasma cells can form a mass that might compress the spinal cord or cause other tumor-related problems. These represent the most common presenting symptoms that contributed to a poor multiple myeloma prognosis in the past.
“I have patients [with multiple myeloma] I have been following for 20 years.” – Ivan Borrello, Myeloma Expert at the Cancer Institute at Tampa General Hospital
Early Advances in Multiple Myeloma Treatment
Prior to the early 2000s, the overall multiple myeloma prognosis was not favorable and treatment options were poor. Basically, treatment consisted of a chemotherapy agent and steroids, which offered little hope for extended longevity. But that changed around 2003 when proteasome inhibitors became available. Proteasome inhibitors essentially prevent multiple myeloma cells from getting rid of old proteins. And as these old dysfunctional proteins build up, the plasma cancer cells die. These medications are now part of first-line care for individuals with multiple myeloma. And they launched a series of advances of multiple myeloma treatments that revolutionized the field. These drugs alone improved multiple myeloma prognosis by almost double after their introduction.
Advances in multiple myeloma treatment accelerated once again in 2015 when monoclonal antibody medications became available. Daratumumab, a CD-38 monoclonal antibody drug, doubled multiple myeloma prognosis once again. This medication and others like it target specific proteins on multiple myeloma cells and destroy them. Today, advances in multiple myeloma treatment regimens now include CD-38 drugs alongside proteosome inhibitors, steroids, and immunomodulating medications. Combined with blood cell transplants, these treatments have made a huge impact on longevity. And more importantly, this type of regimen has facilitated the ability to use personalized care to achieve best outcomes.
“If [ongoing precision therapy] trials pan out, in the next five to 10 years, we might be able to cure a subset of myeloma patients.” – Saad Usmani, Chief of the Myeloma Service, Memorial Sloan Kettering Cancer Center
Leveraging Precision and Personalized Care
The advances in multiple myeloma treatments described can be considered precision medicine types of interventions. However, personalized medicine treatments of this cancer have also evolved as of late. Specifically, stem cell transplants represent a game changer when it comes to multiple myeloma prognosis. In this instance, a person’s stem cells are harvested from their blood once diagnosed with multiple myeloma. Stem cells are the body’s cells that can still evolve into any tissue type, and they are vital when trying to recreate a healthy bone marrow. After the stem cells are taken, the patient then undergoes chemotherapy to destroy all the multiple myeloma cells in the body. Then, the harvested stem cells are returned to repopulate the patient’s bone marrow with non-cancerous cells.
Stem cell transplants are not the only personalized care intervention for multiple myeloma. Other advances in multiple myeloma treatment include genetic reengineering of T-cells and the use of Bi-Specific antibodies. The former refers to genetically altering white cells to attack a specific patient’s multiple myeloma cells. The latter is used in combination with the former to enhance multiple myeloma cell destruction. Currently, these approaches are only being used for those who relapse. But ongoing trials are testing these treatments as first-line treatments for multiple myeloma. The increased multiple myeloma prognosis among patients who have received these newest treatments have been impressive. This is why multiple myeloma experts anticipate a potential cure for many with this form of blood cancer in the near future. And this is why multiple myeloma even today is considered an example of the success precisions and personalized care offers.