Is Multiple Myeloma Cancer Curable?

Multiple myeloma is a cancer that leads to abnormal proliferation of plasma cells. Plasma cells are of white blood cells lineages that are responsible for immunoglobulin (antibodies) production. The malignant proliferation of plasma cells leads to production of abnormal proteins and immunoglobulins. These deposit in various organs and systems, including renal system causing damage along with suppression of immune system. The malignant transformation of plasma cells has a negative impact on other blood cells leading to decrease in red blood cells, white blood cells and platelets. Due to involvement of the bone marrow there are increased chances of bone pathology and hypercalcemia due to increased osteoclastic activity.

The various signs and symptoms associated with the disease process are fatigue, weakness, anemia, bleeding, ecchymosis (due to thrombocytopenia), infections (due to leucopenia), pathological fractures, bone pain, carpal tunnel syndrome, macroglossia, skin lesions, kidney stones, renal failure, hepatosplenomegaly, cardiomegaly, myopathy, neuropathy, shoulder pad sign, diarrhea, constipation, paresthesias, dysesthesias of lower extremity, muscle weakness, paralysis of extremities, hazy vision, confusion, seizures, nausea, and headaches.

Is Multiple Myeloma Cancer Curable?

Multiple myeloma has no cure till date; however, the prognosis and outcome has drastically improved in the patients with multiple myeloma. Although, multiple myeloma is not curable in recent times, there is ongoing research aimed at finding therapies to cure this disease. There are a lot of clinical trials and studies around CAR-T cell therapy in multiple myeloma cases. The results in the clinical trial have shown positive results in nearly/completely eliminating the cancer. Sensitive detection techniques also correlated with the finding in nearly eliminating the myeloid cells, which showed only traces of malignant cells per 100,000 normal cells. It is an encouraging finding with regards to the selection of the patients as all the selected patients had multiple relapses and had an average of seven prior treatments. Although, CAR-T cell therapy is used only in clinical trials and in multiple relapse cases, the discussion continues whether to use this therapy in early stages of the disease. (1)

If approved and used in future, this innovation will have positive implications in the early management of multiple myeloma and who knows a probable cure for the disease is just around the corner. However, further studies and research are required in this field and it will be years before any groundbreaking outcome is achieved. The main challenges behind CAR-T cell therapy is the extreme complicated nature of treatment, cytokine storm and other life threatening side effects and extremely expensive nature of treatment.

Although, until date there is no cure for multiple myeloma, there is significant improvement in the survival rate of patients suffering from this condition. Patients can now live up to 10 years and more, with a median survival rate of 3 years and 5 year survival rate of 46.6%. Recent advances in treatment with high dose chemotherapy and stem cell transplantation have increased the 5 year survival rate to more than 50%.

The current treatment plan of multiple myeloma includes induction therapy, consolidation and maintenance therapy. This may be achieved by medications, stem cell transplantation, radiation therapy and surgical intervention along with palliative care. Systemic medications to destroy myeloid cells include chemotherapy, targeted therapy and immunotherapy.

Chemotherapeutic drugs destroy cancer cells by attenuating their growth and replication. The common drugs used are cyclophosphamide, doxorubicin, melphalan, etoposide, carmustine and cisplatin. These drugs may be used in conjunction with steroids or targeted therapy.

Targeted therapy is used to target specific cancer genes, proteins and environment for cancer growth and survival. Drugs used are bortezomib, elotuzumab, lenalidomide, carfilzomib, ixazomib, daratumumab, pomalidomide, thalidomide and panobinostat.

Immunotherapy is aimed at increasing the natural immunity of the body to fight cancer. Drugs used are thalidomide, lenalidomide and pomalidomide. (2)

In addition bone modifying drugs, such as bisphosphonates and denosumab are also given to reduce the risk of pathological fracture and associated pain. Prednisone and dexamethasone are also given in combination with chemotherapy and targeted therapy.

References:

  1. https://www.ascopost.com/issues/may-25-2018/weighing-the-cost-and-value-of-car-t-cell-therapy/
  2. https://www.cancer.org/cancer/multiple-myeloma/treating/chemotherapy.html

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