Multiple myeloma is a heterogeneous malignancy whose understanding and management have evolved significantly over the past decade. This cancerís complexity is in large part associated with its numerus chromosomal abnormalities, subtypes, and end-organ implications, all which require highly individualized consideration.
Multiple myeloma is a B-cell malignancy characterized by an overproduction of plasma cells. These cells then similarly overproduce paraproteins (i.e., immunoglobulin) which in turn have negative secondary effects on organs (i.e., renal, bone, neurologic, bone marrow, immune function).1 The median patient age at diagnosis is 70 years, hence, the presence of comorbidities may influence treatment options. Male gender and African American descent are other risk factors.
There are numerous systemic treatment options available for multiple myeloma including the use of proteasome inhibitors, immunomodulatory drugs, chemotherapy, corticosterioids, histone deacetylase inhibitors, and monoclonal antibodies.2 Yet, while treatment options have increased in nature and number, multiple myeloma remains an incurable cancer. Hope, however, is on the horizon. The following represents some recent advances in understanding this malignancy.
Diagnostic criteria have been revised such that ultra high-risk smoldering myeloma is now considered actual myeloma in need of treatment;
Enhanced response rates associated with triplet induction therapies containing proteasome inhibitors and immunomodulators, are now the standard approach for initial treatment;
High-dose therapy followed by autologous transplant has proved efficacious in improving response rates and extending progression-free survival;
On the immediate horizon are newer immune approaches such as vaccines and antibody-based immune manipulations to manage this malignancy.3
Like the majority of cancers, multiple myeloma is a malignancy of advanced age. Thus we can expect more cases in the future with the graying of our society. There is great hope that with recent discoveries, multiple myeloma will soon be transformed into an indolent, chronic disease rather than a uniformly life-threatening one.
Kurtin S, Faiman B. The changing landscape of multiple myeloma: Implications for oncology nurses. Clin J Oncol Nurs. 2013 Dec;17 Suppl:7-11.
Dowling M, Kelly M, Meenaghan T. Multiple myeloma: Managing a complex blood cancer. Br J Nurs. 2016 Sep 8;25(16):S18-28.
Dhakal B, Girnius S, Hari P. Recent advances in understanding multiple myeloma. Version 1. F1000Res. 2016; 5: F1000 Faculty Rev-2053.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...