Myeloma treatment always depends on the characteristics of each patient, their evolution and the degree of involvement of the Agency and medical advances.
Until a few years ago the treatment more common systems to control myeloma were different types of chemotherapy, steroids and high-dose therapy and transplantation of stem cells. However, since relatively recently, have introduced new treatments: thalidomide, bortezomib and lenalidomide (which is an analog of Thalidomide), that are shifting to chemotherapy.
There are also a number of treatments of support that help treat the symptoms and complications that myeloma may cause. These supportive treatments include a group of drugs called bisphosphonates that are used to combat the destruction by myeloma of bone tissue, painkillers that relieve bone pain and also, erythropoietin, suitable for anaemia.
However, before embarking on a particular treatment, both the patient and the medical team must make important decisions regarding the best treatment or best suited to the patient and the application times.
The next sections will focus on some important points of decision making with regard to the treatment and provide an overview of the treatments available both to treat myeloma and to treat their symptoms and complications.
The treatment of multiple myeloma is performed in different phases:
1. Induction treatment (of initial or first line)
The initial treatment of patients with multiple myeloma depends, among other factors, age and prognosis.
Thanks to substances such as thalidomide, lenalidomide and bortezomib, in recent years have been important advances in the treatment of multiple myeloma. At present, these new drugs are used alone or in combination with others, at different stages of the treatment and they have helped those affected can live longer and better.
Currently there are combination therapies for the treatment of multiple myeloma in front, which are used both new drugs combined, and new drugs with one or more of the so-called standard therapies (melphalan, prednisone, doxorubicin, and dexamethasone), and even are investigating along with the bone marrow transplant.
The mechanisms of action of Thalidomide made the triple combination of melphalan, prednisone and Thalidomide (MPT) to act more effectively in patients who suffer from multiple myeloma and receive treatment for the first time (first-line therapy) that the double combination (MP) without Thalidomide. Other combinations with three equally effective drugs.
2. Maintenance treatment
In patients who respond to initial treatment, the goal is to prolong the duration of remission with the fewest possible side effects. Consolidation or maintenance in multiple myeloma treatment is that is administered once completed the treatment that has obtained remission, partial or total.
- Treatment for under 65 years:
Patients under age 65, after first-line treatment continues, if the patient has achieved complete or partial remission with intensive chemotherapy and autologous transplantation, which maximized, in a short period of treatment (close to the four weeks with the recovery from the effects of intensive therapy) reduction in tumor mass of myeloma.
- Treatment for 65 years or older:
In patients over 65 years, after first-line treatment, is often stop treatment and wait if the patient markers remain stable (plateau phase) until once again show signs of activity. This is due to the vitality of the body of the elderly deteriorates after prolonged treatments.
The option to continue with a maintenance dose treatment most casualties of one of the new agents (either with Thalidomide or lenalidomide, bortezomib, combined or not with steroids) for several months or years can be beneficial in the long run.
Given that there are several options for the treatment of multiple myeloma, these can be applied in successive manner. If the therapy applied in the first place has no effect (resistant myeloma), or let it lapse (relapse) following therapies can be tested. The patient has to find out about the different possibilities, in a way can figure out together with your doctor what is the most appropriate therapy.
The patient should consult all possible treatments that could be adapted to your case, be also interested in the reasons for the proposed treatment and learn about the advantages, disadvantages and possible alternatives with your doctor. It is also important that the treatment of multiple myeloma suits at all times other derived pathologies (e.g., reduction of the functions of the kidney).
There are many more possible treatments, more decisive will be discovering which of all is best suited to each case.
It is possible that the patient may personally weighed the advantages and disadvantages of a therapy different from other patients. Therefore have to tell your doctor what are the most important factors (for example, a therapy with few reactions adverse, even though its effectiveness be weakened by it, or have less contact with the clinic, for their usual life rhythm is affected the least possible and you can enjoy, for example, planned holidays).
Therapy depends on as well as Comorbidities (for exanple restricted kidney function, a disease of the heart, etc), the age, General conditions of life and other personal circumstances.
Important research on multiple myeloma in many university hospitals, medical centers and other institutions have been doing around the world. Each year, scientists find out more about what causes the disease and ways to improve treatments. Many new drugs are now being tested.
Researchers have found that tissues in support of bone marrow and bone cells produce growth factors that increase the growth of myeloma cells. At the same time, myeloma cells produce substances that cause bone cells undergo changes that weaken bones.
These discoveries are helping researchers develop new drugs to block these growth factors, slow the cancer and reduce the destruction of the bones. For example, cells that support the bone marrow (stromal) produce Interleukin-6 (IL-6). Since IL-6 is a powerful growth factor for multiple myeloma cells and eventually destroys the bone, a part of the current efforts of research focuses on creating ways to block the function of IL-6.
A form of arsenic, arsenic trioxide, being used to treat certain kinds of leukemia, and also being tested to treat myeloma.
Drugs that act differently from those who have been using are being studied. One of them, the panobinostat is a histone deacetylase inhibitor, which means that it affects the proteins in the chromosomes. This drug shows very promising results when used in combination with bortezomib (Velcade) and dexamethasone.
In recent years, has been a test called gene expression profiling for use in multiple myeloma. This test seeks to determine which genes are active in cancer cells, and could indicate if and when a patient with multiple myeloma will need to receive chemotherapy. However, it will be necessary to work much more with this test before it can be used routinely.