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Multiple myeloma. An update on diagnosis and management
1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Acta Oncologica (Stockholm, Sweden)
|January 1, 1990
Summary
Differentiating multiple myeloma (MM) from monoclonal gammopathy (MGUS) and smoldering MM (SMM) is crucial. While treatments like chemotherapy and bone marrow transplantation show promise, challenges remain in eradicating myeloma cells effectively.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Accurate differentiation between multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) is essential for appropriate patient management.
- The plasma cell labeling index serves as a valuable diagnostic tool for distinguishing these conditions.
Purpose of the Study:
- To review current therapeutic strategies and challenges in managing multiple myeloma.
- To evaluate the efficacy of different treatment modalities, including chemotherapy and bone marrow transplantation.
Main Methods:
- Review of existing literature on multiple myeloma diagnosis and treatment.
- Analysis of treatment outcomes for single-agent versus combination chemotherapy.
- Assessment of bone marrow transplantation (allogeneic, syngeneic, and autologous) efficacy and challenges.
Main Results:
- No significant survival difference was observed between single alkylating agent therapy and combination alkylating agent therapy.
- Alternating cycles of interferon alpha 2 and VBMCP achieved complete or near-complete responses in 41% of patients.
- Allogeneic and syngeneic bone marrow transplantation demonstrated some benefit, while autologous bone marrow transplantation offers potential for broader application.
Conclusions:
- Effective eradication of myeloma cells from bone marrow and during autologous transplantation remains a significant challenge.
- Myeloma cell purging using monoclonal antibodies and chemotherapy, along with autologous peripheral blood stem cell rescue post-high-dose therapy, are key areas of ongoing research and application.