In many cancers you hear about the concept of “stages” to describe the progression or classification of the disease. Multiple myeloma doctors use the concept of “risk” to place people in different disease categories.
Not everybody who gets multiple myeloma has the same risk. Some patients have what is called standard risk. Other patients are high-risk. And the risk depends upon irregularities in the chromosomes of their cancer cells:
- Standard RiskThis is typically characterized by extra copies of some of the chromosomes.
- High RiskThis is typically characterized by a missing part of chromosome number 17
Read More These gene differences control the aggressiveness of the cancer cells. Standard risk has “a better prognosis” whereas high risk myeloma “confers a much poorer outcome,” according to
Dr. Kenneth Anderson, Director of the Multiple Myeloma Center at Dana Farber Cancer Institute. So when it comes to treatment, in the first two phases there is no difference. But the treatment approach differs in the third phase. Here’s how it works.
- Induction Phase: This phase is the same regardless of risk. It consists of a triplet drug therapy
- Stem-Cell Transplant Phase: This phase is the same regardless of risk. It consists of chemotherapy coupled with a stem-cell transplant.
- Maintenance Phase: This phase will differ based on the risk-profile.
During this maintenance phase standard risk patients are given only Revlimid (Ienalidomide), a drug that acts on the immune system, daily for three weeks. In contrast, high risk patients are given Revlimid (Ienalidomide) daily for three weeks in addition to a proteasome inhibitor every other week. In short, the standard risk patients need one drug while the high-risk patients need two. Lenalidomide has been shown to extend overall survival in the standard risk patients. But Anderson says, “A proteasome inhibitor needs to be added in with the lenalidomide in the high risk patients in order to achieve that benefit.”
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Dr. Kenneth Anderson is the Director of the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute. Read More