Hematologist Nikoletta Lendvai is part of a multidisciplinary team at Memorial Sloan-Kettering that every year treats more than 250 patients with multiple myeloma and other plasma-cell diseases.
At Memorial Sloan-Kettering, our doctors take a multidisciplinary team approach to multiple myeloma and related diseases, drawing on the expertise of hematologic oncologists, radiation oncologists, radiologists, pathologists, bone marrow transplant specialists, and pain specialists who collaborate closely on each patient’s care.
Team members use state-of-the-art diagnostic tools to help determine the most effective course of treatment for each patient. Memorial Sloan-Kettering specialists treat more than 250 new patients each year with multiple myeloma and other plasma-cell diseases.
New Therapies
Thalidomide, a medicine first used in the late 1950s as a sleeping pill and to combat the nausea some women experience in the first trimester of pregnancy, was found to cause birth defects and was later banned. In the late 1990s, cancer researchers discovered that thalidomide is an effective treatment for myeloma throughout the course of the disease as both first-line and maintenance treatment (given to help keep the cancer in remission). It is also given to patients whose disease has relapsed.
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Through our clinical trials, Memorial Sloan-Kettering investigators showed that nearly 90 percent of patients with myeloma responded to a combination of thalidomide plus dexamethasone when given after a regimen of dexamethasone combined with the chemotherapy drug doxorubicin. Dexamethasone is a medication used to counteract certain side effects of chemotherapeutic treatment. Patients show a high response rate when dexamethasone is combined with thalidomide, although the combination can sometimes cause side effects. These include blood clots and a serious skin disorder called toxic epidermal necrosis. However, we have found that a majority of patients are able to tolerate the treatment. We completed one of the first clinical trials using thalidomide for multiple myeloma, and over half the patients treated in that trial survived more than seven years after their diagnosis.(1)
We also use a blood test — a serum-free light-chain assay — which can predict the likelihood that a patient will achieve a complete, or near-complete, response to therapy. Our researchers have also shown that bortezomib (Velcade®), the first in a new class of medicines called proteasome inhibitors and the first new treatment in more than a decade to be approved for the treatment of multiple myeloma, is effective in newly diagnosed myeloma patients. By combining bortezomib with traditional medicines (liposomal doxorubicin and dexamethasone) and continuing treatment with thalidomide, over half of newly diagnosed patients with symptomatic disease achieve complete and near-complete responses, making stem cell transplant even more effective.
Stem cell transplant is a method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.
Stem Cell Transplantation
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Autologous transplantation is commonly used in treatment of multiple myeloma and some forms of lymphoma.
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At Memorial Sloan-Kettering, we are committed to improving the outcomes of patients who undergo stem cell transplantation for the treatment of multiple myeloma. Stem cell transplant is a standard therapy for newly diagnosed myeloma patients and is usually offered as part of therapy in the first year after diagnosis. On average, patients who receive a stem cell transplant at our hospital do extremely well. (More than 99 percent of myeloma patients who receive transplants at Memorial Sloan-Kettering survive the most dangerous period following the procedure, which is the first 100 days.) In addition, we have developed new growth factors and other medications to increase the number of stem cells that are available for collection.
Researchers are not only testing new treatments but are developing diagnostic tools such as microarray analysis, a DNA test that analyzes the expression of thousands of genes and can profile an individual’s cancer to determine the treatment to which each patient is most likely to respond.
Learn more about stem cell transplantation at Memorial Sloan-Kettering.
Expertise in Amyloidosis
Primary amyloidosis (AL) is a condition in which abnormal plasma cells produce a light-chain protein (M protein), a part of an antibody that collects in organs such as the kidney, heart, liver, and nerves and interferes with their normal function. About 10 to 15 percent of patients with myeloma will either have or develop amyloidosis. We treat amyloidosis with a combination of chemotherapy and stem cell transplantation.
AL amyloidosis is sometimes confused with familial amyloidosis at diagnosis. By using additional screening procedures, Memorial Sloan-Kettering physicians ensure that patients are correctly diagnosed and treated.
Our physicians have special expertise in treating amyloidosis, particularly when it involves the heart. We collaborate with other New York City hospitals that provide heart transplants to selected patients with amyloidosis. We also have an excellent record of success using stem cell transplants to treat these patients; many do well despite sometimes irreversible heart damage from the amyloidosis. Our AL patients with damage in the kidney, liver, gastrointestinal tract, or peripheral nervous system usually improve following treatment that includes a stem cell transplant.
We also pioneered a treatment program combining autologous stem celltransplantationwith the drugs thalidomide and dexamethasone, and now with the combination of bortezomid and dexamethasone.(2) This approach markedly reduces or eliminates the problematic protein in almost all AL patients who receive this treatment. We are currently studying ways to further increase stem cell mobilization and to improve the overall care of patients who undergo autologous stem cell transplantation.(3)
Other Plasma-Cell Diseases
Memorial Sloan-Kettering also treats patients with related plasma-cell diseases. These diseases include systemic light-chain amyloidosis (AL), a rare and often fatal disease, and less serious disease conditions, such as solitary plasmacytoma and monoclonal gammopathy of undetermined significance (MGUS).
Learn more about our approach to treatment of other plasma-cell diseases.
Focus on the Individual
We believe that treating the whole person — not just the disease — is the best approach for patients and family members. At Memorial Sloan-Kettering, we offer a broad range of emotional support programs designed to help patients and family members cope with the range of issues related to life during and after cancer treatment.
- Hassoun H, Reich L, Klimek VM, Dhodapkar M, Cohen A, Kewalramani T, Zimman R, Drake L, Riedel ER, Hedvat CV, Teruya-Feldstein J, Filippa DA, Fleisher M, Nimer SD, Comenzo RL. Doxorubicin and dexamethasone followed by thalidomide and dexamethasone is an effective well tolerated initial therapy for multiple myeloma. RL.Br J Haematol. 2006 Jan;132(2):155-61.
- Cohen AD, Zhou P, Chou J, Teruya-Feldstein J, Reich L, Hassoun H, Levine B, Filippa DA, Riedel E, Kewalramani T, Stubblefield MD, Fleisher M, Nimer S, Comenzo RL. Risk-adapted autologous stem cell transplantation with adjuvant dexamethasone +/- thalidomide for systemic light-chain amyloidosis: results of a phase II trial. Br J Haematol. 2007 Oct;139(2):224-33.
- Comenzo RL. Managing systemic light-chain amyloidosis. J Natl Compr Canc Netw. 2007 Feb;5(2):179-87.
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