Multiple Myeloma

[MacGyver]

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Whats the prognosis in terms of % survival for 1, 5, 10 years?

Cant find any info on this.

 

[MustafaMond]

The question is complex because it depends what therapy you get.
Hope this info I drudged up helps you mac. 👍

Chemotherapy is usually the first treatment recommended for multiple myeloma. In most individuals, chemotherapy partially controls multiple myeloma; rarely, chemotherapy leads to complete remission. The response to initial chemotherapy also helps to estimate how long an individual will survive.

A definition of a response to chemotherapy refers to a 50 percent reduction in blood and urine levels of the abnormal M protein and an improvement of symptoms. Individuals who have any response to chemotherapy (even if it does not meet the above definition) survive, on average, 43 months, while individuals who do not have a response survive, on average, 19 months.

Between 50 and 60 percent of individuals with multiple myeloma have a response to melphalan-prednisone chemotherapy. The average survival among individuals treated with this chemotherapy is three years.





TRANSPLANTATION ?
Transplantation, when successful, prolongs survival, can lead to a remission, and, in rare cases, may cure multiple myeloma. However, transplantation has several problems. The high-dose chemotherapy (even with radiation) given before transplantation may fail to kill all of these cells, allowing the condition to relapse. Such treatment also puts the patient at risk for serious infections and bleeding, which might be fatal.

Effectiveness of transplantation ? About 7 percent of individuals die from complications related to transplantation. However, compared with chemotherapy, autologous bone marrow transplantation is more likely to produce a response and a complete remission, and is associated with survival approximately 12 months longer than that produced by chemotherapy alone.

Single versus double autologous transplantation ? Some studies suggest that double autologous transplantation (two consecutive autologous transplantations) may be more effective than single autologous transplantation for treating multiple myeloma. The second transplantation is usually performed within six months of the first.

Among individuals undergoing double transplantation, 51 percent have a complete remission, and the remission lasts, on average, 50 months. One study has shown that double transplantation improves long-term survival relative to single transplantation.

Interferon therapy after autologous transplantation ? Interferon therapy after autologous transplantation may be recommended for some individuals. Studies suggest that in individuals undergoing autologous bone marrow transplantation, interferon therapy delays the onset of a relapse and leads to better survival in the short term.

Allogeneic bone marrow transplantation ? An allogeneic stem cell or bone marrow transplantation is a treatment option for only 5 to 10 percent of individuals with multiple myeloma. This type of transplantation has two advantages over autologous transplantation: the donated stem cells do not contain any malignant plasma cells, and the transplanted cells may target and help control any remaining myeloma cells. This latter beneficial effect is called the "graft versus tumor" effect. However, allogeneic transplantation is also associated with a "graft versus host" effect, in which cells from the donor may attack tissues of the host, resulting in damage to various organs, such as the skin, liver, and intestines.

Allogeneic transplantation requires bone marrow or stem cells from a donor with a matching tissue type. Under the best conditions, a sibling may qualify as a donor; otherwise national bone marrow donor banks may be employed to find a donor with a matching tissue type. The donated bone marrow or stem cells are given to the patient after he/she receives appropriate doses of high-dose chemotherapy and radiation to reduce the number of malignant plasma cells.

Up to 52 percent of individuals have a complete response after allogeneic transplantation. Thirty percent of individuals live for at least four years, and 20 percent of individuals live for at least 10 years. The likelihood of a complete response to allogeneic bone marrow transplantation is highest in individuals with a lower number of myeloma cells and in individuals who have had a complete response to the initial chemotherapy.

Although multiple myeloma usually relapses after allogeneic transplantation, some individuals are cured of multiple myeloma after this type of transplantation.

Unfortunately, approximately 25 percent of individuals who undergo allogeneic transplantation die from transplant-related complications, such as infection, lung inflammation, and graft-versus-host disease. Thus, the potential benefit of allogeneic transplantation (long-term disease control or cure) must be weighed against the potential for immediate morbidity and mortality.

Donor lymphocyte infusion ? Donor lymphocyte infusion is currently an experimental procedure. This procedure is an option for individuals who have a relapse of multiple myeloma after allogeneic bone marrow transplantation. During this procedure, lymphocytes collected from the original donor are given to the individual; these lymphocytes target the myeloma cells and may produce a beneficial "graft versus tumor" effect. Fifty-two percent of individuals have a response to this procedure, and 22 percent of individuals have a complete response.

Syngeneic transplantation ? A syngeneic transplantation refers to a transplantation between identical twins. For individuals who have an identical twin, this treatment option is more effective than either autologous or allogeneic transplantation. The average survival without a progression of multiple myeloma is 72 months.

Other transplantation programs ? Because autologous transplantation is not often curative and allogeneic transplantation carries a high mortality, other solutions have been sought. These include "mini transplants" (also called nonmyeloablative transplants) in which the patient receives a lower dose of chemotherapy prior to an allogeneic transplant. Another strategy, which is currently being evaluated, is a tandem transplant in which the patient first receives the less toxic autologous transplant followed by an allogeneic transplant at a time when the patient is more able to tolerate this procedure.

Remission after transplantation ? The strict definition of remission requires that there are no signs or symptoms of multiple myeloma and that highly sensitive tests do not detect any abnormal plasma cells. This type of remission occurs in about 4 percent of individuals after autologous transplantation and about 19 percent of individuals after allogeneic transplantation.

 

[Adawaal]

I would agree with most of what Mustafa posted. [Not sure where that was "drudged up," but probably best to cite the reference when quoting it en bloc like that....] I will say that the info for mortality rates of auto BMT for MM may be a little low, and it may have likewise overshot the mortality of an allo. Most mortality rates for BMT are only for the acute period (12 weeks or so) and tend to be due to the obvious period of neutropenia involved -- at least for full myelo-ablative regimens. If you're really interested in the topic, you might want to take a look at a new trend in ex vivo expansion of the granulocytic stems in an auto. Neutropenic periods have been cut by more than half, dramatically reducing peri-transplant mortality, especially in particularly at-risk patients. A couple of folks are now doing cords and double cords for myeloma as well.

 

[MacGyver]

I prefer not to use the terms "partial" or "complete" response because they are basically worhtless parameters from a patients point of view.

Those terms just refer to specific numbers of abnormal plasma cells found in peripheral blood counts. But since relapse is so common, the only thing I think thats relevant from a patient's perspective is overall survival rates and time to remission.

Ok, so here's a summary of survival rate data thusfar:

Overall data for all MM patients:

5 year: 30%

Allogenic Bone Marrow Transplant:

4 year: 30%
10 year: 20%

Single Autologous Bone Marrow Transplant:

+ 1 year compared to chemo alone

Double Autologous Bone Marrow Transplant:

4 year remission period

MP chemo regimen:

4 years: 50%

Twin Bone Marrow Transplant:

7 year remission period

Autologous Stem Cell Transplant with Chemo:

1.5-2 year remission
5 years: 50%

What about some of the newer procedures? does anybody have survival/remission data on that? Again, I dont care about partial/complete response rates, just overall remission/survival data.

 

[MustafaMond]

I would agree with most of what Mustafa posted. [Not sure where that was "drudged up," but probably best to cite the reference when quoting it en bloc like that....] .

Its from UptoDate. I didn't want to say that because I was worried about copyright infringement. The numbers are different depending on were you look.
This is another good site on MM.
http://www.oncolink.com/types/article.cfm?c=13&s=42&ss=336&id=9177


I am no expert on the subject, and so I cut and paste some good text for this guy-->

I prefer not to use the terms "partial" or "complete" response because they are basically worhtless parameters from a patients point of view.

What about some of the newer procedures? does anybody have survival/remission data on that? Again, I dont care about partial/complete response rates, just overall remission/survival data.

MacGyver...noone here gives a $hit about what you think is valid data.
You are a pretty dense, and I don't know why I would think you had changed, and that I could help you learn. You've got a lot to learn about cancer, if you think you can just find a sheet of numbers and start throwing around mortality data.

And by the way...Who cares what you "prefer" to tell the patient? You are no more intelligent than one, and don't assume that patients are so dumb that they can't understand things like plasma cell counts.

I don't appreciate you demanding tone, in regards to the information we post out of
WTF? Do you think this a carry-out research kiosk?
This is not a McDonald's where you can just order a cheeseburger and drive away.
Do your own damn research, and knock yourself out, tool.
👎

 

[MacGyver]

MacGyver...noone here gives a $hit about what you think is valid data.

And nobody here gives a **** about what you think is valid data, either. So I guess we're equal in that regard. 🙄

You are a pretty dense, and I don't know why I would think you had changed, and that I could help you learn.

Oh please. You copied and pasted from a source. YOU certainly taught me well huh?

Thank you mr bigshot doctor. Thank you for learnin' me about dat oncolology stuff 😴

You've got a lot to learn about cancer, if you think you can just find a sheet of numbers and start throwing around mortality data.

I didnt tell you what I was using the data for or how I was using it.

You need to brush up on your reading comprehension skills. Assuming facts not in evidence isnt a good thing for practicing medicine, I'm sure.

And by the way...Who cares what you "prefer" to tell the patient? You are no more intelligent than one, and don't assume that patients are so dumb that they can't understand things like plasma cell counts.

Who cares what you prefer to tell the patient? Did you mistake me for someone who actually gives a **** about your bull**** opinions? I asked for data, not opinions. If you dont want to give it, then dont click on the thread, dont read it, and dont waste time posting about something you have no interest in.

When I started this thread, I didnt title it "Mustafa please give me data" so please quit assuming this was a personal request or that you HAD to comply.

I don't appreciate you demanding tone

Your opinion is duly noted. 😴

Do you think this a carry-out research kiosk?

Are you setting the agenda for SDN now? If you dont want to provide data, THEN BY ALL MEANS DONT DO IT. Please dont allow me to twist your arm into clicking on a thread you have no interest in and typing a response. I know that my powers must be strong to have such a pervasive influence on your behavior from thousands of miles away, but please dont let it be a hindrance to you.

This is not a McDonald's where you can just order a cheeseburger and drive away.

WTF? Do you want me to bow down in submission?

Ohh MustafaMond, I'm not worthy of the glory of your oncological insight!

Please teach me in the way of the oncology master!

If its praise and glory you want, have fun waiting for it from me.

Do your own damn research, and knock yourself out, tool.

Who's the tool here? The person who posted the thread, or the person who bitches about the thread, goes out of his way to show how displeased he is with the thread, and posts **** that is totally irrelevant to the topic.

Nobody forced you to reply, notwithstanding my all-universe powers that must be persuasive in their attempts to force an idiot such as yourself to engage in a thread you have no interest in.

 

[Krafty]

Don't fret yourself Mustafa...

This narcissistic joker hangs around and likes to take the most offensive stances on controversial issues 👎 (discrediting foreign grads).

macgyver gets off on being offensive to people, it asserts his weak self esteem 😡 (just look at his quote). Always has to have the last word. I think he got made fun of a lot in middle school. Then again that's usually the story with most surgeons.

I mean, who writes pages and pages, analyzing everything you said just to get in the last toolish comment.

Watch him come back and wag his tail back at me. 😉

 

[UTSouthwestern]

Just put him on your ignore list. Just about everyone on the anesthesiology board does and it's so much more pleasant to read without comments from the god complex squeaker.