by JPC on Sat Jan 30, 2016 10:47 am
Hi Dogmom:
Keep in mind that some of the statistics, particularly the older ones, are even worse than the ones you mentioned. The medium age of diagnosis is something like 67 years old. Many of the older patients do not find it early (they start to have age-related aches and pains, anyway, that are somewhat normal at that stage), and are frail when it is uncovered. There was an older statistic that 1/3rd of the patients diagnosed with multiple myeloma did not make it to 3 months. I think that statistic is lower now, but it is probably higher than one would like to think.
Also, multiple myeloma is the second most frequent blood cancer after leukemia, but it is still less than 2% of all cancers, and in the general population, many people do not have a clue as to what the condition entails (most people would rather not want to think of cancer at all in any form, unless they are forced to).
But, exactly as you state, the newer news is significantly better.
It is very unfortunate to get the condition at a young age, but paradoxically, if you do, and if you are healthy outside of the multiple myeloma issues, then for the majority of patients, the myeloma can be brought under control. Once you have it to a state of control (say VGPR or better), then the outlook is much better than even 3 or 4 years ago based on not only the new drugs approved in the last year, but also an overall improvement in the state of the art in sequencing the induction, autologous stem cell transplant (ASCT), consolidation, and maintenance.
They will also over time learn how better to sequence the new drugs into the mix. For example, most drugs initially get approved for relapsed and refractory, but eventually move up the chain and into initial induction to improve progression-free survival and overall survival. That was the story, for example, for Revlimid and Velcade.
Two drugs in particular, are not yet approved for initial induction – I am thinking about Kyprolis and daratumumab – that investigators are working on now to bring into initial induction. I am not a doctor, but just reading the literature, I can pretty safely predict that KRD-dara would probably be better than anything out there now for initial induction, and I am quite sure that some of the investigators are thinking how to get that approved (or something like it).
In the case of daratumumab, there are clinical studies for its application in smoldering multiple myeloma. The thought process behind that is that since the side effects for the monoclonal antibodies are thought to be near term only, that you can do better than just watch and wait before active multiple myeloma kicks in, in some cases. This is quite interesting in that they are working on leapfrogging the newly approved daratumumab (which is only approved right now for relapsed/refractory) even before initial induction.
So you are quite correct, the story is much better than 10 years ago. One of the areas of concern, and I think will start to get more focus, is what to do for some of the bad cytogenetic abnormalities, which about 1/4 to 1/3 of newly diagnosed multiple myeloma patients have. As others have mentioned, I am grateful that right now there is significant progress in multiple myeloma treatment right now, more so than most other cancers.
Rgds,
Yes, I work as a med tech, and we diagnose much more leukemia and lymphoma than we do myeloma in our lab.