If a person is suspected to have multiple myeloma due to the presented signs and symptoms, some investigations are required to confirm the diagnosis of the disease which help in staging and selecting an appropriate treatment approach.
Plasma Cell Dyscrasia treatment depends on many factors including but not limited to type of plasma cell disorder, stage of the disease, performance status of the patient, comorbidities, patient’s preference, along with other factors.
Following are the preferred treatment approaches for different plasma cell disorders, but the final decision is taken after clinical assessment of the patient by an oncologist.
Plasma Cell Dyscrasias Treatment Options
Radiation therapy is the preferred treatment for solitary plasmacytoma. In case of extramedullary plasmacytoma, surgical resection of the affected soft tissue followed by radiation therapy may be employed.
Patients with MGUS are recommended to be followed-up closely without treatment. Only about 1% of patients with MGUS face progression to multiple myeloma per year.
Smoldering multiple myeloma
Patients with smoldering multiple myeloma are also recommended to be followed-up closely without treatment. In case of any sign of disease progression, chemotherapy can be employed as the first line of treatment.
Patients with the symptomatic disease are recommended to be treated with induction therapy constituting multiagent regimen (mostly a combination of corticosteroid, immunomodulatory drug, and proteasome inhibitor).
After completion of the induction therapy, patients who are the good candidate for stem cell transplant may undergo the procedure if there is an indication.
Maintenance treatment may be required after induction in some patients.
Brief description of various treatment types employed for multiple myeloma:
Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly-growing cancer cells. Chemotherapy is employed in combination with other therapeutic agents for the management of multiple myeloma. Depending on the physician’s preference and patient’s condition, it may also be combined with immunomodulatory drugs and corticosteroids to accelerate the benefit achievement. It may be associated with side effects like nausea/vomiting, hair loss, fatigue, cytopenias, etc due to its effect on normal body cells apart from cancerous cells.
These are a category of drugs which are structurally similar to cortisone, a hormone produced by the adrenal cortex. Examples of corticosteroids include dexamethasone, prednisone, etc. that are generally employed in the treatment regimen for multiple myeloma. These drugs may have side effects like hyperglycemia, weight gain, mood changes, weakness in bones etc.Immunomodulatory Drugs in the treatment of MMrole of Immunomodulatory Drugs in the treatment of MM?
Bisphosphonates (e.g. Zoledronic acid and Pamidronate) are a class of drugs which helps in maintaining bone density and reduce the occurrence of skeletal-related events. Normally, bones are constantly remodeled by two types of bone cells: osteoblasts (they increase bone density) and osteoclasts (they decrease bone density).
Bisphosphonates decrease the activity of osteoclasts by inducing apoptosis (natural cell death) in them, and thus, help in maintaining bone density and to relieve symptoms of bone metastasis.
Radiation therapy (or radiotherapy) uses high-energy x-rays or other high-energy radiations which are directed to the affected area to kill cancerous cells.
For multiple myeloma treatment, an external radiation source (external beam radiation therapy) is generally employed, whenever indicated. Radiotherapy is mostly used to treat solitary plasmacytoma or used for palliation of symptoms of the advanced-stage disease such as pain, swelling, or spinal cord compression.
Surgery is rarely employed for the treatment of multiple myeloma but it may be employed for treating solitary plasmacytoma especially that affecting soft tissue, for example, the tissue lining the sinuses.
Stem Cell Transplant (SCT)
The SCT is generally employed for the treatment of multiple myeloma in patients who are the good candidate for SCT (younger patients in good health) and in whom there is an indication to do the same.
In this technique, patients own stem cells are first collected from the healthy bone marrow tissue or peripheral blood (free from disease). Then, the patient receives high-dose chemotherapy to kill all cancerous cells.
The collected stem cells are re-administered to the patient which slowly replenish the blood cells in the patient body. Sometimes, a second autologous SCT is employed 6 to 12 months after the first SCT. This is known as Tandem SCT.
Various research studies have revealed that Tandem SCT can be more beneficial than single SCT in some selected patients.
In this technique, healthy stem cells to be administered to the patient after high dose chemotherapy are obtained from another person known as the donor.
It is very important that donor is a close blood relative (preferably a sibling) so that donor cells closely match with the patient’s cell types. There is risk of graft-versus-host disease in which the new immune cells originated from donor’s cells attack the host cells.
This may help in improving the overall quality of life by providing relief from the symptoms caused by myeloma. These include but are not limited to using drugs to reduce pain and other symptoms such as vomiting, fatigue or external-beam radiation therapy for bleeding or pain, etc.
Following are goals of treating multiple myeloma:
- Prolongation of life.
- Reduction of symptoms.
- Improvement of overall quality of life.
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