• Multiple myeloma is a plasma cell tumor, which is treatable but not curable
  • The standardized treatment for patients who are ineligible for stem cell transplantation, is lenalidomide plus dexamethasone
  • Daratumumab plus lenalidomide and dexamethasone treatment showed lowered risk of progression of the disease, or death

Introduction – Multiple myeloma is a plasma cell tumor, whose cause is unknown(1)(2). However there is a close link between Multiple myeloma and Monoclonal Gammopathy of unknown significance (MGUS)(3). Plasma cells are matured B cells, who produce antibodies, which in our case are abnormal and grow rapidly. Plasma cells can form a mass in the bone marrow and soft tissue. If only one mass is present, it is called plasmacytoma in contrast to multiple masses  ̶  multiple myeloma. Risk factors for Multiple Myeloma include obesity, radiation exposure, family history and certain chemicals(4)(5).

Figure 1 shows a healthy bone marrow in the left side, and Multiple Myeloma in the right side, where abnormal antibodies are formed. Image adapted from(6)

Statistics – It is estimated that in year 2015, globally,  488,000 people were affected by Multiple Myeloma, which resulted in 101,100 deaths (7). 1 in 100 people with MGUS develops Multiple myeloma, every year. Myeloma is more common in men, adults over 60, and twice more in blacks than in white and asian populations(3)(1).

Figure 2 shows a graphic , which includes the average number of new cases per year, age and gender of patients with Multiple Myeloma. Image adapted from (8)

Diagnosis and current treatment – The doctor bases the diagnosis in the patient signs, symptomps and these tests: blood tests, urine tests, imagine tests and the examination of bone marrow. After that, the patient is classified in one of the three stages(9). Multiple myeloma is treatable, but not curable. Treatments for myeloma include:

  1. Targeted therapy (e.g.: Bortezomib, carfilzomib and ixazomib)
  2. Biological therapy (e.g.: thalidomide, lenalidomide and pomalidomide)
  3. Chemotherapy
  4. Corticosteroids(e.g.: prednisone and dexamethasone)
  5. Bone marrow transplant
  6. Radiation therapy (beams of energy, such as X-rays and protons)

Latest research – The standardized treatment for patients with newly diagnosed Multiple Myeloma who are ineligible for stem cell transplantation, is lenalidomide plus dexamethasone. The purpose of the latest article concerning the addition of daratumumab was to significantly reduce the risk of disease progression or death in this population. 737 patients with Multiple myeloma were randomly assigned to receive daratumumab  plus lenalidomide and dexamethasone. Disease progression or death had occurred in 240 patients at a median follow at 28 months (97 of 368 patients [26.4%] in the daratumumab group and 143 of 369 patients [38.8%] in the control group). 70.6% of patients were alive without disease in the daratumumab group in contrast to 55.6% in the control group. 47.6% of patients responded completely or better to the daratumumab group, whereas only 24.9 to the control group. A total of 24.2% of the patients in the daratumumab group, as compared with 7.3% of the patients in the control group, had results below the threshold for minimal residual disease (1 tumor cell per 105 white cells) (P<0.001). The most common adverse events of grade 3 or 4 were neutropenia (50.0% in the daratumumab group vs. 35.3% in the control group), anemia (11.8% vs. 19.7%), lymphopenia (15.1% vs. 10.7%), and pneumonia (13.7% vs. 7.9%). We can conclude that according to the results of this study  the risk of disease progression or death was significantly lower among those who received daratumumab plus lenalidomide and dexamethasone than among those who received lenalidomide and dexamethasone alone(10)(11). 

Figure 3  Prespecified Subgroup Analysis of Progression-free Survival.
Image adapted from (11).

COPYRIGHT: This article is the property of We Speak Science, a non-profit institution co-founded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by Veton Guraziu  (University of Prishtina, Kosovo).

References:

  1. The Lancet, Multiple Myeloma (22.6.2009), Retrieved May 30, 2019, from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60221-X/fulltext
  2. Bernard W. Stewart, Christopher P. Wild, World Cancer Report 2014, Haematopoietic and lymphoid malignancies, Multiple Myeloma, pg. 712-713, published by International Agency for Research on Cancer, 2014
  3. NHS, Multiple Myeloma(11.4.2018), Retrieved May 30, 2019, from: https://www.nhs.uk/conditions/multiple-myeloma/
  4. NIH, Plasma cell neoplasms(including Multiple Myeloma) (9.4.2019) Retrieved May 30, 2019, from: https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq#section/all
  5. Fred F. Ferri, Ferri’s Clinical Advisor 2014, Multiple Myeloma, pg.783-784, by Mosby, an imprint of Elsevier Inc, 2014, 2015
  6. Diseases and Conditions, Multiple Myeloma(22.11.2017), Retrieved May 30, 2019, from: https://diseasesandconditions.net/multiple-myeloma/
  7. NCBI, Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 (8,10,2016), Retrieved May 30, 2019, from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577/
  8. Cancer Research UK, Myeloma incidence by age, UK, 2013-2015, Retrieved May 30, from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/myeloma/incidence#heading-One
  9. Mayo Clinic, Multiple Myeloma (15.12.2017), Retrieved May 30, 2019 from: https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
  10. NCBI, Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma (30.5.2019), Retrieved May 31, 2019 from: https://www.ncbi.nlm.nih.gov/pubmed/31141632
  11. NEJM, Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma (30.5.2019), Retrieved May 31, 2019, from: https://www.nejm.org/doi/full/10.1056/NEJMoa1817249?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed