From the Guidelines
Definition of Multiple Myeloma
Multiple myeloma is a type of blood cancer characterized by the proliferation of malignant plasma cells in the bone marrow, accounting for approximately 1% of all cancers and 10% of hematologic malignancies 1. This proliferation leads to the production of monoclonal immunoglobulin, causing skeletal damage, hypercalcemia, renal insufficiency, anemia, and infections 1.
Key Features and Complications
The disease is slightly more common in men and in African Americans, with a mean age of affected individuals being around 62 years for men and 61 years for women 1. The hallmark features of multiple myeloma are often remembered by the acronym CRAB: Calcium elevation, Renal insufficiency, Anemia, and Bone disease 1.
Treatment Approach
The initial treatment approach typically involves a combination of medications, including proteasome inhibitors, immunomodulatory agents, and corticosteroids. A common first-line treatment regimen may include lenalidomide, bortezomib, and dexamethasone [@Example@]. For patients who are transplant-eligible, high-dose melphalan followed by autologous stem cell transplantation may be considered [@Example@]. Supportive care measures, including bisphosphonates and erythropoiesis-stimulating agents, may also be necessary to manage bone disease and anemia [@Example@].
Monitoring and Adjustment of Treatment
Regular monitoring of response to treatment, including serum protein electrophoresis, complete blood counts, and bone marrow biopsies, is essential to adjust the treatment plan as needed [@Example@]. The treatment of multiple myeloma has evolved dramatically over the past decade with the introduction of new drugs, leading to a significant improvement in median overall survival, which now approaches 6 to 10 years, depending on the age of the patient at diagnosis 1.
From the FDA Drug Label
- 1 Multiple Myeloma POMALYST, in combination with dexamethasone, is indicated for adult patients with multiple myeloma (MM) who have received at least two prior therapies including lenalidomide and a proteasome inhibitor and have demonstrated disease progression on or within 60 days of completion of the last therapy.
Multiple myeloma (MM) is not directly defined in the provided drug labels. However, based on the context, it can be inferred that multiple myeloma is a type of cancer that requires treatment, and POMALYST is indicated for adult patients with this condition who have received prior therapies. 2
From the Research
Definition and Characteristics of Multiple Myeloma
- Multiple myeloma (MM) is a hematological cancer characterized by the proliferation of malignant plasma cells in the bone marrow (BM) 3, 4, 5.
- It is the second most frequent hematological malignancy, accounting for 1% of all cancer and 13% of hematological tumors, with approximately 9,000 new cases per year 3.
- MM is typically diagnosed in individuals ages 65 to 74 years 6.
- The disease is characterized by the production of abnormal immunoglobulins and can progress from monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) 3, 6, 4.
Diagnostic Criteria and Clinical Characteristics
- MM has specific diagnostic criteria, including hypercalcemia, renal insufficiency, anemia, and bone lesions (CRAB criteria) 6.
- Patients with MM often experience clinical manifestations such as recurrent infections, renal disease, hypercalcemia, bone disease, pain, hyperviscosity syndrome, infections, thromboembolic events, and anemia 6.
Treatment and Prognosis
- MM management involves corticosteroids, chemotherapy, and autologous stem cell transplantation, as well as addressing complications 6.
- Despite the introduction of new treatments, the prognosis of MM patients is still poor, with a survival time range of 5 to 7 years for newly diagnosed patients 6.
- The disease is currently incurable, and novel therapeutic approaches are being tested, including immunotherapy and targeted therapies 3, 7.
Role of the Tumor Microenvironment
- The tumor microenvironment (TME) plays a crucial role in MM development and progression, with soluble factors and direct cell-cell interactions regulating MM plasma cell trafficking and homing to the BM niche 4, 5.
- The BM microenvironment consists of a cellular and non-cellular compartment, including stromal cells, endothelial cells, osteoclasts, and osteoblasts, which influence cell proliferation, drug resistance, and prognosis of the disease 5.