Talk:Multiple myeloma

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To-do list for Multiple myeloma:

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Here are some tasks you can do:

1 Doom and Gloom
2 Can someone clarify the assessment of bone lesions used in staging, please?
3 Rituximab
4 Bob & Vince

[edit] Doom and Gloom

The way this article is written makes it seem like anyone who gets the disease will likely die within 2-5 years, and that it always relapses. Strides are being made every day in the treatment of this disease, and this article isn't reflective of the fact that there is hope for patients with Multiple Myeloma, thanks to the ever-continuing cutting edge technology and treatment methods. Maybe the article is just out-dated? I don't know. Granted, the prognosis still isn't good for this disease, but I believe things are getting much better, and that there's a lot more hope for MM patients than before. 24.14.105.100 02:57, 17 October 2007 (UTC)

As an addition to the Doom and Gloom article I wholeheartedly agree with the comments. In my own case I was diagnosed with MM in April 1999 after suffering many of the symptoms described in the main article. I underwent chemo therapy and had a stem cell transplant in September that year. All I want to say to fellow sufferers is please take heart. It is now eight years down the road and I have a good quality of life with a rewarding and chalenging full time job. Please do not dwell on what you have got but just look forward to tomorrow and live life to the max. —Preceding unsigned comment added by 81.153.6.169 (talk) 12:39, 17 October 2007 (UTC)

I think that the "doom and gloom" part that you are seeing is due to the fact that MM is technically incurable. While great strides have been made in treating it, nothing cures it. I am happy to hear that you have been in remission for 8 years and counting. Unfortunately, my mother was diagnosed at age 62 in Stage IIIB (the kidney failure was diagnosed first, then her plasmacytoma was found the following week), and despite thal/dex, VAD, Velcade (which gave her the best quality of life and remission), melphelan with an autologous stem cell transplant, and Revlimid, she still died 26 months after diagnosis. And the therapies themselves gave her other problems (she had to have heart bypass surgery a month after diagnosis, a month later suffered seizures and stopped breathing several times, and was hospitalized with encephalopathy many times due to treatments staying in her system longer than dialysis could get them back out). Her final therapy was Revlimid/dexamethasone, which we pulled her off of only 4 days before she died. Unfortunately, she was in the majority of cases, though not for her age group (and she was very healthy before the MM).

I do not know how old you were at diagnosis, but many patients are still in their 70s and older at diagnosis, which makes prognosis more difficult (and I am guessing that, since you were symptomatic, you were diagnosed in stage III?). But I've noticed a trend for MM striking at younger ages lately, I know of people in their 40s and 50s with symptomatic MM, and they tend to have the best prognosis. Also, I am guessing that you don't have renal failure. That makes prognosis shorter, because battling renal failure and MM is very hard. My mother died of Sepsis, by the way, due to her suppressed immune system (she survived pneumonia 3 times after dx). The stem cell transplant, while successful, only gave her 2 months of remission.

So I guess my point is, while you are right to give your fellow MM patients hope that it IS a treatable cancer, it remains an incurable one, and there are many problems that MM causes that lowers the general prognosis of the average MM patient. My regards to you and your continued success in treating your MM, I hope you skew the prognisis curve!Kelelain (talk) 16:49, 8 December 2007 (UTC)

[edit] Can someone clarify the assessment of bone lesions used in staging, please?

The scheme as outlined here differs from the original, described in Durie and Salmon (1975), in which bone lesions were graded on a four point scale, namely: Normal bones (0); Osteoporosis (1); Lytic bone lesions (2); Extensive skeletal destruction and major fractures (3).

Stage I included normal bones (0) or solitary plasmacytoma, stage II by implication included osteoporosis (1) or lytic bone lesions (2), and stage III included scale point (3), now defined as 'Advanced lytic bone lesions' in the table describing the staging system.

Does anyone have a reference that supports the grading of bone lesions as laid out in the current Wikipedia article? I note that this scheme is that used by the CIBMTR, except for the inclusion of osteoporosis in stage I which the original scheme of Durie and Salmon include in stage II and which the CIBMTR ignore altogether.

As ever, there is nothing new under the Sun and this point has been raised elsewhere, although not answered as far as I know, before (see http://radiology.rsnajnls.org/cgi/reprint/234/1/313.pdf). However, the current scheme is not based on the Durie and Salmon PLUS staging system, in which lesions are determined using MRI and/or FDG PET, referred to in the Mulligan letter.

Any pointers would be appreciated. By the way, please tell me if this is not the right forum for raising this question and where is.Johnacle (talk) 00:46, 2 January 2008 (UTC)

I'm not sure how the grading of bone disease plugs into the full D&S system. JFW | T@lk 10:19, 28 March 2008 (UTC)

[edit] Rituximab

13-22% might respond to anti-CD20 monoclonal antibody: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2141.2008.07024.x JFW | T@lk 07:10, 17 March 2008 (UTC)

doi:10.1182/blood-2007-10-121285 - numerous conditions seem to increase myeloma risk as a nonspecific trigger. JFW | T@lk 00:39, 25 March 2008 (UTC)

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2141.2008.06997.x - PAD (Bortezomib, doxorubicin and dexamethasone) as first-line treatment does fairly well. JFW | T@lk 10:11, 28 March 2008 (UTC)