Pat Killingsworth Pat Killingsworth

Should multiple myeloma patients fear secondary cancer risk?

The risk of developing a secondary cancer following years of ongoing treatment was a red-hot issue one year ago.

Why?  A clinical study–presented at last year’s ASH meetings in Orlando–showed multiple myeloma patients have an 8% risk of developing a secondary cancer if they use Revlimid maintenance following a stem cell transplant.

The day following the announcement, Celgene (they make Revlimid) stock crashed almost 10%.

It was soon determined that this risk did not apply to patients who had never had a stem cell transplant using high dose melphalan.  Apparently, it was the combination of the melphalan and patient use of Revlimid over four years or longer that caused the secondary cancer risk to measurably jump.

By spring, the Celgene stock price had recovered and things calmed down a bit.

But in April, we learned that the FDA was investigating the issue.  Here is a link to an article I wrote about this on April 12th:

FDA Keeping an Eye on New Malignancy Concerns With Lenalidomide

As it turns out, the whole issue was probably overblown.  Top myeloma experts worldwide came forward to reassure patients and caregivers that any secondary cancer risk was far too small to justify eliminating such an important and effective drug from their multiple myeloma treatment plan.

At the large ASCO meetings last June in Chicago, one of these international myeloma experts, Dr. Antonio Palumbo, presented results of a comprehensive study of the issue.

Based on the results of this retrospective analysis, Dr. Palumbo concluded that Revlimid ,when used with melphalan, did in fact raise the rate of secondary cancers.

But the good news was the group confirmed that using Revlimid does not increase secondary cancer risks in patients who had not undergone stem cell transplants.  And apparently using dexamethasone–along with Revlimid–also reduced the risks.

I heard very little about the issue at this year’s ASH in San Diego.

But Dr. Palumbo did do a follow-up presentation.

Here is a link to an article that Patrice Wendling wrote for The Oncology Report about Dr. Palumbo’s secondary cancer risk update:

Second-Cancer Signal Affirmed After Lenalidomide for Myeloma

The report concluded that after 4 years of follow-up, second cancers were diagnosed in 2.1% of patients, based on data collected from over two thousand patients.

According to the article, Dr. Palumbo ” noted that the risk of multiple myeloma progression is between 10 and 15 times higher than the diagnosis of a second cancer, and suggested that the emphasis on second cancers may be overshadowing the risk of death due to toxic effects and infections. ”

What I found interesting was this.  In her follow-up research, Patrice Wendling found that “Swedish researchers recently reported that the risk of AML and myelodysplastic syndromes is 11.5-fold higher in multiple myeloma patients than in the general population, even before the introduction of novel agents.” (Blood 2011;118:4086-92)

Editor’s note: AML (acute myeloid leukemia) was found to be the most common type of secondary cancer caused by continual, long term use of Revlimid post-transplant.

Best I can tell, none of this takes into account situations like mine this past year–when I developed melanoma–most likely as a result of a compromised immune system from using Revlimid for more than four years.

Before I share my feelings about the secondary cancer issue tomorrow, how do you–my readers–feel about all of this?

Is it much to do about nothing, or something that concerns you enough to keep you up at night?

Are we having fun yet?  Isn’t this where I get to add how HAVING CANCER REALLY SUCKS!

Feel good and keep smiling!  Pat