Treatment of Relapsed/Refractory Multiple Myeloma - Episode 1

Imaging and Treatment Advances in Multiple Myeloma

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There have been substantial advancements in the diagnosis and treatment of multiple myeloma over the past decade. Older diagnostic practices include obtaining a skeletal survey via x-ray imaging. While this is a useful tool, says Raje, it was only positive in about 60% to 70% of people with multiple myeloma.

Better diagnostic procedures have contributed to the improved prognosis of those with multiple myeloma. With the advent of computed tomography (CT) scans, positron emission tomography scans (PET), and magnetic resonance imaging (MRI), practitioners are beginning to move away from solely x ray imaging and incorporating innovative imaging techniques in their diagnostic workup. Raje notes that not every patient undergoes each of these imaging modalities, but adds that it is helpful to have these options available for specific circumstances, such as in patients with smoldering myeloma, plasmacytoma, macrofocal disease, or oligosecretory disease.

A skeletal survey is usually insufficient in distinguishing smoldering myeloma from multiple myeloma. Raje says more specific imaging tools, such as PET scans and MRI, are valuable in this context. In patients with a plasmacytoma, which is an isolated collection of plasma cells, a PET scan or MRI can be used to check whether a patient has other signs of disease. In macrofocal and oligosecretory diseases, it can be challenging to follow the disease course without these imaging tools. As a result, Raje comments that she would certainly use a PET scan in these patients.

Similarly, multiple myeloma treatment approaches have evolved from earlier standards of care such as VAD (vincristine, doxorubicin, dexamethasone) or thalidomide and dexamethasone-based inductions to regimens that involve triple and sometimes quadruple combinations of more advanced therapies. As a result, there has been tremendous benefit in patient outcomes, where new treatment improvements have dramatically changed the overall survival of multiple myeloma patients, according to Raje. As a result of these advances, median overall survival has increased from 2.5 years to more than 10 years in many cases, Lonial adds.

Raje and Lonial both comment that the diagnosis and treatment practices in multiple myeloma have come a long way in the past decade. Due to advances in the past 10 years, Lonial estimates that around 15-20% of patients are cured of multiple myeloma due to current standard therapies such as lenalidomide, bortezomib, dexamethasone with or without maintenance therapy, and high dose therapy with autologous stem cell transplant.