Toward a cure for multiple myeloma?

Article Abstract:

At present, multiple myeloma, a tumor involving specific bone marrow cells, is essentially incurable; fewer than half of all patients are likely to live three years. In the October 31, 1991 issue of The New England Journal of Medicine, researchers report considerable progress in the treatment of multiple myeloma. The adverse effects of increasing the doses of chemotherapeutic treatment were offset by following the treatment with bone marrow transplantation to replace the healthy bone marrow cells destroyed by the aggressive treatment regimen. In this study, allogeneic bone marrow transplantation was used, that is, bone marrow from a closely matched donor. Forty percent of the 90 patients in this study are expected to live five years. However, there are many aspects to this treatment of multiple myeloma that must be considered. In allogeneic bone marrow transplantation, there is a good chance that the immune system cells in the donor marrow will attack the cells of the recipient. This response, called graft-versus-host disease (GVHD), will kill some transplant patients. Furthermore, the risk of serious GVHD increases with age, but the authors do not recommend allogeneic transplantation for patients over 55. Since the risk of multiple myeloma increases with age, this means that this new treatment would not be recommended for 75 percent of all multiple myeloma patients. However, older patients may receive autologous bone marrow transplantation. With this technique, some of the patient's own bone marrow is removed prior to chemotherapy and is replaced later. This avoids the risk of GVHD. However, in contrast with an allogeneic transplantation, the autologous bone marrow may also return malignant cells back to the patient. Further research will be necessary to determine the relative risks of these procedures and if the increase in deaths due to GVHD are balanced or exceeded by improvements in the length of remission from myeloma. Multiple myeloma is sufficiently uncommon, so that the formation of cooperative groups between medical centers will be necessary to resolve such questions conclusively. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bone marrow, Bone marrow transplantation, editorial

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Thalidomide and hematopoietic-cell transplantation for multiple myeloma

Article Abstract:

The assessment of whether the addition of thalidomide would further improve survival among patients with multiple myeloma is presented. The results have shown that thalidomide increased the frequency of complete responses and extended event-free survival at the expense of added adverse effects without improving overall survival.

England, Patient outcomes, Dosage and administration, Hematopoietic stem cells, Hematopoietic stem cell transplantation, Thalidomide

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The role of the Wnt-signaling antagonist DKK1 in the development of osteolytic lesions in multiple myeloma

Article Abstract:

Patients with a type of cancer called multiple myeloma produce a protein that causes the bone abnormalities that often occur in these patients. The protein is called the dickkopf1 (DKK1) protein. It is involved in bone metabolism, and excessive amounts cause bone loss.

Physiological aspects, Bone resorption, Osteolysis

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