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When patients come to our clinic with myeloma-related conditions, the first thing we will need to determine is whether or not treatment is necessary. To make this determination, we will run a battery of tests that will help us see what type of myeloma a person has. Some types, like MGUS and asymptomatic myeloma, may require no treatment at all, but rather careful monitoring to see if the disease progresses.
If treatment is needed, we will then work with you to determine a plan that is right for you. The standard of care for multiple myeloma patients typically involves treatment using autologous stem cell transplants. These are transplants in which the patient’s own healthy stem cells are collected and then given back after the patient has received intensive chemotherapy.
If the chemotherapy treatment would be given without stem cell support, it would take 6 to 8 weeks before a patient's blood counts would return to normal levels that prevent infection and bleeding. This would be too risky, especially for older patients.
However, by giving stem cells back as soon as the high dose chemotherapy is out of the body, we can reduce this period of vulnerability to infection and bleeding to approximately one week. This will allow us to perform transplants in patients up to the age of 75-80 and even makes it possible to perform these transplants on an outpatient basis.
Autologous transplants are our standard of care because the median survival rate associated with treatment using back-to-back (tandem) autologous transplants is significantly better than the survival rate with conventional chemotherapy treatment.
Data show that with autologous transplants, 50% of myeloma patients will survive more than 10 years, while the median survival for patients who have conventional chemotherapy is 2-3 years, with only 5% of such patients living 10 years or longer. Not only will patients who have received tandem transplants live longer, their quality of life will be better.
The quality of life of myeloma patients is directly related to the amount of myeloma cells in the body. Tandem autologous transplants will reduce the amount of myeloma cells much more than conventional therapy or treatment with newer drugs. Therefore, patients who have received tandem transplants will be in better shape.
However, we realize that autologous transplantation may not be the right option for every multiple myeloma patient. Some people may not be in proper health to receive such treatment and others may simply prefer a different method. Therefore, we also offer other kinds of treatment for multiple myeloma, including:
• Treatment with newer drugs, like Velcade, Thalidomide, and Revlimid
• Treatment with a combination of newer drugs and conventional chemotherapy
• Clinical trials (evolving therapies)
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