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Ask The Expert Archive

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Multiple Myeloma Archive Questions

Below are Dr. Badros’s answers to Multiple Myeloma questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 57.

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Q : 1

How does MM develop in a young person who is otherwise very healthy, and has no family history of MM? Can it be transmitted through transfusions?

It is transmitted through transfusions. There is no clear cause for myeloma that has been identified at this time.

Q : 2

Is it possible to receive Velcade via injection at any hospital and is it covered by insurance companies?

It is covered by insurance for treatment of MM. You will need an oncologist to prescribe the drug. Most physicians have privileges at one or two hospitals and that means you will have to chose someone in close proximity to the hospital you want to go to. Also, many private oncologists can give drugs at their offices as an alternative option.

Q : 3

My mom was diagnosed with MM, after suffering compression fractures of T12, L1 and L2. She's had kyphoplasty and is 76 years old. Why would her doctor decide to start her on radiation instead of chemotherapy?

Radiation therapy can help control the pain. She needs a full work up that includes blood, urine for evaluation of myeloma proteins called Ig and a bone marrow examination. If she has systemic disease, she will need chemotherapy after radiation is completed. She should be on zometa to help control bone disease. You should discuss her case with the physician and if you're unhappy, get a second opinion.

Q : 4

My dad was recently diagnosed with multiple myeloma. He has gone through 4 rounds of 3 drug chemo (velcade, dexamethasone and revlimid). His current m protein level is 0.1. We understand that autologous stem cell transplant is the standard of treatment in his case, but he is hesitant. What are his options for maintenance therapy? Do any of these medications preclude him from an autologous transplant in the future?

Yes, SCT is the standard of care for MM patients who qualify for it. It is also true that certain therapies, especially if used for long time such as melphalan and possibly revlimid (long-term use), can affect our ability to collect stem cells. Transplant is one of the many options for MM patients and it should be discussed with your physician as well as a transplant center that treats MM patients.

Q : 5

If they placed my mother at stage three multiple myeloma, what would be the most likely form of treatments? She is showing signs of all stage three symptoms. She is very weak.

This means she is in an advanced stage. As you indicate, choice of therapy is mostly chosen depending on the patient's condition and risk factors of multiple myeloma. In general, therapy includes induction, consolidation with stem cell transplant (if age and organ functions are appropriate), and then maintenance.

Q : 6

My husband has MM and has lost about 3 to 4 inches in height. Will he get those inches back once he is better?

Unfortunately, the height lost due to bone loss is permanent. That said, therapy and zometa/aredia can help prevent further bone loss.

Q : 7

My 46-year-old-mother is a newly diagnosed MM patient. She is suffering from serious back pain and there are 12 tumors spread all over her body. According to the doctor, my mother's disease did not respond to the first 2 Velcade injections. Is it a must for her to do a bone marrow transplant? Will her bone marrow regenerate as radiotherapy might destroy existing bone marrow? Can she have an autologous bone marrow transplant instead of receiving the bone marrow from a healthy donor?

I believe that SCT is a standard of care for patients younger than age 65. True radiation can damage stem cells, but attempts to collect stem cells should be attempted. I think auto is much more appropriate as the first step for MM patients and in selected few, allo can be considered.

Q : 8

In November 2008, my 62-year-old mother was diagnosed with MM stage IIIb IggKappa. She has suffered several fractures and tried many different treatments with little success. Now, her doctors want her evaluated for ASCT. Does this sound routine?

ASCT is standard of care for MM patients. The data suggests that these patients still benefit from SCT now, however a lot of authorities recommend at least collecting stem cells and waiting for a relapse to do SCT. This is an option I do not like for many reasons: 1. we get older with time and SCT may get more complicated 2. Once you reach Medicare age, you can not do SCT if you have progressive disease and there is always a risk that you will not respond a second time. In short, my opinion is to go with SCT now, then maintenance afterward with lenalidomide.

Q : 9

How long does a person usually live with multiple myeloma?

Myeloma patients' survival has improved significantly in the last few years. For each individual patient, survival is dependent on many factors. These are called prognostic factors and include presentation, B2M, cytogenetics, preexisting conditions, general health, etc. For a more specific answer, you should discuss these factors with your physician.

Q : 10

How useful is a FISH analysis and Plasma Cell Labeling Index in a bone marrow biopsy? Should multiple myeloma patients request these tests as part of standard protocol?

PCLI is difficult to perform outside of very few institutions. However, FISH should be performed on every MM patient as it is the most powerful prognostic marker in MM because of its ability to predict who will do well and for how long.

Q : 11

My family member is 67 and was just diagnosed with MM. His creatinine jumped to 5 from normal within one month and he is about to start Revulimid and Decadron. Could he be a candidate for stem cell transplant? He is otherwise healthy.

High creatinine alone is not a contraindication for stem cell transplant. But in general Revlimid is poorly tolerated in patients with high creatinine. In these cases, I usually prescribe Velcade. There may be other options, but you should address these with the treating physician.

Q : 12

I am a 35-year-old female diagnosed with smoldering myeloma with 30% plasma cells. Leukopenia and nuetropenia present. IgA 1900. M-spike of 0.7g/dL and Kappa Light Chain 46.31 and Lamdda Light chain 9.30. No skeletal survey yet, but would like to know if there are little or no bone lesions, in similar case scenarios, would prompt treatment be advisable?

I think you need additional testing results before calling it smoldering, including hemoglobin, skeletal survey, renal function, 24-hour urine for total protein and UPEP. If it is truly smoldering, which is unlikely with the frequent infections, then follow-up is indicated. Once a therapy decision is made, at age 35 you would be a candidate for induction with many drugs to choose from, followed by stem cell transplant and then maintenance. This is more or less standard of care for patients your age. I would recommend a follow-up in a myeloma center close to you.

Q : 13

My sister was just diagnosed with smoldering myeloma and has a cell count of 10. Her doctor recommended drawing blood every two months to monitor her condition. Why don't they treat her condition while the cells are not proliferating out of control? Is Gleevac a treatment option?

There is no indication to treat smoldering disease; observation is the substandard of care as there is only a 10% chance of progression to active myeloma each year. Gleevac has been shown in vitro, in the lab to effect bone remolding and osteoclast in patients with myeloma, but I am unaware of any clinical trails for Gleevac for this disease.

Q : 14

How effective is stem cell transplant against multiple myeloma?

It is the standard of care for patients less than 65 and even 70 if they have good organ function. In many studies, eligible patients who received a stem cell transplant showed improvement in disease free survival rate and overall survival rate.

Q : 15

What is the criteria to be considered a candidate for bone marrow transplantation? I am a 74-year-old male and was diagnosed with MM three years ago. It was treated then, but now it has returned.

In general patients less than 65 years of age are offered transplant as a standard of care. However, many older patients with good performance status can have a transplant. The use of transplant as salvage therapy after three years will depend on many factors including collection or availability of stem cells, organ function, response to salvage therapy, e.g. velcade and/or cytoxan.

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