Myeloma Cure Panel Highlights: Dr. Parameswaran Hari Talks On Multiple Myeloma Disease Progression and Treatment – Part 1
Dr. Parameswaran Hari was the myeloma expert on the recently broadcast myeloma cure panel. Dr. Hari spoke in detail about myeloma disease progression and provided panelists and listeners with graphic details of the condition. Click here to listen to the Myeloma Cure Panel broadcast.
The web panel discussion began with Dr. Hari responding to co-host and editor of myelomasurvival.com, Gary Petersen’s question on multiple myeloma background and recommendations for treatments. Dr. Hari was of the opinion that a better term for ‘relapse’ as far as multiple myeloma patients were concerned was, ‘disease progression’. Myeloma progresses and is known as relapse when the condition returns after a remission.
Myeloma is considered to be in remission when myeloma cells cannot be detected at all. A patient is said to be in complete remission or CR when all tests show that there are no myeloma cells. A patient is said to be in partial remission or PR when there are some myeloma cells detected…but not full-blown disease. A third type of remission is called Stringent Complete Remission and occurs when more sensitive techniques fail to gauge presence of myeloma cells in patient.
Relapse occurs when the disease grown again after a remission. There is no absolute universal rule that all patients would have to confront a remission some time or other. Dr. Hari clarifies that over 10 to 15% of people never progress to a relapse. And prolonging this remission period is and should be the target for treating multiple myeloma.
The first remission is important since this is usually the longest progression free period for the disease and the length of this remission decides further treatment. Dr. Hari clarifies that the second and third remissions would be shorter. Thus, we come back to the first treatment schedule which would aid in giving the patient a long first remission.
Time is valuable and disease control for long time is the aim. This can be achieved in different ways,
– Following a multidrug chemotherapy regimen
– Combination drug regimen
– Upfront stem cell transplant followed by maintenance to prevent relapse
– Consolidation therapy
A very recent study by the CALGB group showed that upfront auto transplant followed by low lenalidomide/Revlimid as maintenance treatment found that 50% of people had no disease for 4 years.
Another treatment regimen could involve opting to freeze stem cells and continue with chemotherapy. When disease progresses, the stem cells can be used for the transplant.
However, Dr. Hari opines that ‘First Remission is the Best Remission’ and as mentioned above the longest too, hence the disease should not be allowed to progress. The disease should be treated aggressively with a combination of three drugs namely, VRD (Velcade, Revlimid and dexamethasone) or CyBorD (bortezomib/Velcade, cyclophophamide, /dexamethasone). Over 60% of new multiple myeloma patients in the US are administered one of the drug combinations mentioned.
In the last decade itself, over 10 to 15% of myeloma patients have enjoyed disease free progression periods/remission and hopefully, in this decade this number can be doubled so that 30 to 40% of patients enjoy progression free survival periods.
This definitely indicates that people who are in treatment currently would fall into this 40% and thereby enjoy longer progression free survival!
Will be continuing Dr. Hari’s take on multiple myeloma treatments…