More Myeloma Treatment
In addition to a hematologist-oncologist, a person's medical team may include a specialist in radiation therapy (radiation oncologist). The team will also include one or more nurses, a dietitian, a social worker, and other professionals as needed.
There is no cure for myeloma but with treatment patients can survive for many years with greatly reduced symptoms and problems. The first goal of medical therapy is to enable the patient to go into a complete remission. This means that there is no detectable monoclonal protein and the number of plasma cells in the bone marrow is normal (less than 5%) after treatment. Remission is not the same as cure. In remission, small numbers of myeloma cells likely remain in the body, but they are undetectable using currently available technology and cause no symptoms. When symptoms resume, or more abnormal plasma cells appear in the bone marrow, or abnormal proteins again start to appear in the blood or urine, the patient is said to have relapsed, and is no longer in complete remission.
- The objectives in achieving complete remission are preventing myeloma-related damage to bones, kidneys, and other organs; prolonging life; relieving symptoms; and preserving a good quality of life for as long as possible.
- Most patients in remission will eventually experience a relapse or be said to have recurrent disease.
- The duration of remission depends on the stage of myeloma and varies by disease characteristics. Remission may be quite variable, lasting for a few months, or for many years. Remission that lasts a long time is called durable remission, which is the goal of therapy. The duration of remission is a good indicator of the aggressiveness of the myeloma. Remission can also be considered partial. A partial remission (also called partial response) means that the level of monoclonal protein decreases after treatment to less than half its level before treatment. A very good partial response means that the level of monoclonal protein decreases by at least 90% from its level before treatment.
Other terms used to describe the myeloma's response to treatment include the following:
- Minor response: The level of monoclonal protein decreases but is still greater than half the original level.
- Stable disease/plateau phase: The level of monoclonal protein stays the same.
- Progression: The level of monoclonal protein worsens during or after treatment. This includes recurrent or refractory myeloma.
- Refractory myeloma: The disease is resistant to the treatment.
A hematologist-oncologist may use the following terms to refer to myelo
- The first line of therapy given for myeloma is often referred to as "induction therapy" because it is designed to induce a remission.
- If this treatment does not induce a complete remission, the person will probably be given a different treatment regimen. This is sometimes called "second-line therapy," or occasionally, "salvage therapy."
- Once the disease is controlled, the person may be given yet more treatment to maintain control. This is called "maintenance therapy."
- Many patients may have sufficiently aggressive myeloma to be considered candidates for stem cell transplantation, which is an intensive, high-dose chemotherapy regimen, followed by infusion of normal donor matched cells (in the form of an allogeneic stem cell transfusion (rare), or -- more commonly, followed by the reinfusion of the patient's stem cells, in the form of an autologous transplant). This form of treatment is sometimes referred to as "consolidation therapy."
Clarence Sarkodee-Adoo, MD
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