Last week, the Multiple Myeloma Research Foundation (MMRF) held a workshop in Chicago titled “Racial Disparities in Multiple Myeloma: Its Effect on the African American Community.” While a previous Beacon article describes the issue of racial disparities, several other topics were also discussed.

Chromosomal Abnormalities – Nearly all patients with multiple myeloma demonstrate an abnormal number of chromosomes. A karyotype, which is a technique that analyzes chromosomes, can signify either good or poor prognosis. For example, having less than the normal 46 chromosomes is an indicator of poor prognosis.

SNPs – Single-nucleotide polymorphisms (SNPs) are inherited changes in DNA that account for 90 percent of human genetic variation. Researchers believe that SNPs may contribute to ethnic differences of risk and toxicity as well as to variability in patient responses to therapy. One day researchers may be able to predict risk based on a patient’s SNPs.

Gene Expression Profiling – Gene expression profiling is another method that can be used to determine whether a patient is standard- or high-risk for a particular outcome. Researchers speculate that patient-tailored therapies based on genetics may become standard procedure in the future.

Stem Cell Transplantation – Studies have shown that patients who undergo stem cell transplantation maintain a better quality of life. If a patient chooses not to have a transplant early on in treatment, he or she can still benefit from it later on. In fact, according to a transplant physician at the meeting, the age cut-off for transplantation is 78 years. Over 90 percent of transplants are autologous, which means that the stem cells come from the patient’s own body.

Tandem transplantation requires patients to undergo two autologous transplants. Researchers at the meeting pointed out that if a patient benefits from the first transplant, the second is typically minimally effective. On the other hand, if there is little benefit from the first transplant, then the second typically helps dramatically.

Drug Combinations – Some researchers are now developing three- or four-drug combinations. In one study, a Velcade/Revlimid/dexamethasone combination showed an overall response rate of 98 percent. In another, Velcade/cyclophosphamide/dexamethasone followed by Velcade/thalidomide/dexamethasone has shown an overall response rate of 90 percent and complete remission or very good response rate in 60 percent of patients.

Also, physicians at the meeting were particularly excited about HDAC inhibitors such as Zolinza (vorinostat) and single transduction inhibitors such as perifosine, since these are entering Phase 3 clinical trials this year.

Vertebral Compression Fractures – A vertebral compression fracture occurs when an individual bone in the spinal column collapses due to weakening of the bone. Multiple fractures can lead to kyphosis, the forward curvature of the back—commonly known as a “hunchback”—that is often seen in multiple myeloma patients. Two treatments are available:

• Vertebroplasty - This is a relatively low-risk procedure involving the injection of a cement material into the affected vertebrae.
• Kyphoplasty - This procedure bears slightly greater risk because the affected bone is first pushed apart. A balloon is inserted between the bone, and cement is injected into the balloon to stabilize the bone. This procedure is able to restore lost height.

No data exist that show one method to be consistently superior to the other. Individual physicians tend to have a personal preference for one of the procedures.

IVC Filter – Hyperviscosity occurs when the blood thickens due to ­­­the build-up of a specific type of protein. This can lead to blood clots, which can move from the leg and get lodged in the lungs. Patients who cannot take blood thinners (because of an ulcer, for instance) can instead be given an inferior vena cava (IVC) filter. The IVC is a large vein that carries blood to the heart and lungs. The IVC filter allows blood to flow while catching any passing clots.