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AMYC: The Academic Myeloma Consortium

 

Myeloma Facts

Myeloma is a cancer of the bone marrow affecting production of red cells, white cells and stem cells, and it can damage bone.

It is also called 'multiple myeloma,' because multiple areas of bone marrow may be involved.

Overview

Myeloma is the second most common blood cancer after lymphomas, affecting an estimated 750,000 people worldwide. In industrialized countries it is being diagnosed in growing numbers and in increasingly younger people.

Myeloma is incurable but highly treatable. Today, there are more than 100 drugs in clinical trials in the United States alone. Multiple drug regimens can be used in combination and in sequence to help some patients maintain their daily routines for years and even decades.

Myeloma specifically affects plasma cells (antibody-producing lymphocytes) within the bone marrow, resulting in:

  • Anemia
  • Destruction of bone tissue
  • Reduced immune function
  • Kidney failure
  • Build-up of M protein (an antibody that is not needed and can cause thickening of the blood)

Symptoms include pain of varying intensity, often in the lower back or ribs with fractures occurring either spontaneously or following trivial injury. Patients have an increased risk of infection. General malaise is frequent; significant weight loss is rare.

Possible Causes — New Findings

The causes of myeloma have been extensively investigated. Several possible causes have been identified, including toxic chemicals, radiation, several viruses, as well as physical and psychological stress factors.

In July 2009, a published study from researchers with the IMF gene bank Bank On A Cure® identified several changes in DNA sequences called SNPs (single nucleotide polymorphisms) that are associated with a risk of bone disease in myeloma. Further analyses showed that many of these DNA changes may be involved with the way the human body responds to certain toxins, providing a possible link between myeloma and environmental contamination.

This may help explain why myeloma is increasingly being diagnosed in patients under 45 years old, including some of the early responders to the 9/11 World Trade Center site.

Multiple Myeloma Statistics

  • Multiple Myeloma (MM) represents approximately 1% of all cancers
  • In the U.S. and most Western industrialized countries the incidence is 3-4/100,000 people
  • 50,000 - 100,000 Americans currently have MM
  • Approximately 20,000 new cases are diagnosed each year in the U.S. Approximately 11,000 Americans die from MM every year
  • The median age of diagnosis is approximately 65 years
  • The five-year survival rate of patients ranges from 10% to 50%. However, with newer treatments, some patients live 10 to 20 years or longer.
  • The male/female ratio is 3:2
  • MM is twice as common in African Americans as in Caucasians

Pathology

Multiple myeloma is a cancer in which plasma cells — important components of the immune system — grow and divide in an uncontrollable fashion and accumulate in the bone marrow. Normal plasma cells make antibodies, or immunoglobulins, that help to fight disease. Myeloma cells also produce the same type of immunoglobulin protein, but this abnormal protein (M-protein) does not help protect the body from infection. In addition, the M protein that is produced can build up in organs such as the kidneys, causing serious damage over time.

Bence Jones Proteins: Myeloma cells produce incomplete immunoglobulin molecules (light chains) that can adhere to each other and to other tissues, and become deposited in tissues and in small blood vessels such as in the kidneys.

MGUS: Monoclonal Gammopathy of Undetermined Significance is asymptomatic myeloma. It should be observed rather than treated.

Treatment

Newer treatments include the "novel therapies," REVLIMID®, VELCADE® and THALOMID® (thalidomide). They are often used in combination with the steroid dexamethasone, or the alkylating agent Melphalan with the steroid prednisone. REVLIMID® is the first in a class of drugs called immunmodulatory drugs or IMiDs® compounds. REVLIMID® and THALOMID® act in the microenvironment of the cancer cells and are oral drugs. VELCADE® for injection is the first in a new class of medicines called proteasome inhibitors that disrupt the life cycle of a cancer cell.

Autologous stem cell transplants use cells taken from the patient's own bone marrow. The cancerous bone marrow cells are treated with high-dose chemotherapy to eradicate the cancer and then returned to the patient.

These approaches extend survival, but are not curative since patients relapse. Physicians may move patients through various treatment regimens in sequence to generate back-to-back remissions.

"Next-generation" drugs are under development and include pomalidomide and carfilzomib. Other treatments include DOXIL® - doxorubicin, a drug that has been used to treat cancer for over 20 years that has been reformulated to be contained in fat bubbles called liposomes. Multiple drugs are used to treat the bone damage associated with multiple myeloma.

(Myeloma Facts adapted from: International Myeloma Foundation. "Multiple Myeloma: Cancer of Plasma Cells in Bone Marrow." Press Release 6 Jan. 2010)

 

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