Myeloma multiplex occurs when the proliferation of a group of immune cells in the body called plasma cells gets out of control.
In recent years, the effectiveness of new treatments for this cancer has been very significant. In this article, we will introduce the latest treatment of multiple myeloma.
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The effect of new treatments for multiple myeloma
New treatments for multiple myeloma has both increased the survival time of patients and improved their quality of life. The main site of plasma cells is in the bone marrow, and therefore, multiple myeloma, in addition to being a type of blood cancer, also known as a bone tumor.
New treatments for multiple myeloma will be able to cure many cases in the near future.
In the last decade, the options available for treating patients with multiple myeloma have been limited and include only limited medications.
Today, a variety of treatments of choice will no longer have the side effects of old drugs. Cardiac and neurological complications were among the common problems that the old treatments for multiple myeloma had.
Increase your chances of survival with new treatments
In the past, the average survival of people with this cancer was six months to two years, but with new treatments, an average survival of eight years per person will be conceivable, which will gradually get longer with scientific advances.
The good news is that although there is currently no definitive cure for multiple myeloma, it responds well to treatment.
What is Plasma Cancer?
Plasma cells are the body’s defense cells that make antibodies against foreign agents and bacteria to kill the foreign cells. When plasma cells become cancerous, they make changes that make an abnormal protein called a monoclonal protein, or M protein.
Ways to treat multiple myeloma
In general now there are six treatments for multiple myeloma:
Target therapy:
In the past, chemotherapy drugs used to kill cancer cells and healthy non-cancerous cells, but today, target therapy is able to selectively have a lethal and destructive effect only on cancer cells and not damage healthy cells in the body.
The three techniques available are:
- Treatments that equip and strengthen your immune system to recognize and destroy cancer cells
- Identify enzymes and molecules that cause cancer cells to grow, multiply and spread, and destroy or inactivate them.
- Identify gene mutations involved in multiple myeloma and use drugs that kill only these mutated cells.
Drugs used in targeted therapy
The following are the drug classes used in targeted therapy:
- Proteasome Inhibitors:
When this group of substances (proteasome) are inhibited or damaged, they accumulate inside the cell and cause cell death.
Proteasome inhibitors used in multiples are usually:
Bortezomib (Velcade):
It is used as an intravenous injection and is especially suitable for patients with kidney problems.
Carfilzomib(Kyprolis):
This drug is used to reduce allergic reactions and is usually injected with dexamethasone. Side effects include fever and chills, vomiting, and sometimes respiratory problems.
Ixazomib(Ninlaro):
This drug has an oral form and is often used after other treatments and is used in combination with other drugs.
- Monoclonal antibodies:
There are substances that, when they enter the body, can only attach to a specific part of some cells in the body and selectively affect only them. These drugs are produced in very special laboratories.
Monoclonal antibodies used in multiple myeloma include:
Daratumumab (Darzalex):
It binds to a specific protein molecule on cancer cells, slowing their growth and even killing them.
Elotuzumab(Empliciti):
This drug is a protein called SIAMF7 which is located on cancer cells, It attaches to cancer cells and helps the patient’s immune system attack the cancer cells.
This drug is also used as an intravenous injection. This medicine can damage the nerves and cause a tingling sensation in the palms and soles of the feet.
Isatuximab (Sarcissa):
It is one of the newest treatments for multiple myeloma and is commonly used in combination with pomalidomide and dexamethasone to slow the growth of cancer cells.
Injection and use of these drugs can lead to allergic reactions, so special care is taken to reduce reactions before and after treatment.
- Antibody drugs conjugates:
This new class of drugs is used for patients who have a history of at least four courses of treatment with previous drugs.
- Blentamab mafodotin blmf(Blenrep) :
It is a drug that specifically targets molecules on the surface of cancer cells. This molecule is called BCMA and is a factor that protects against cancer cells.
The drug consists of two components, the first component attaches to the cancer cell and the second component, which is a toxin, enters the cell and kills it.
Side effects of drugs in this category (target therapy) are minor and include the following:
- Fatigue
- Fever
- Easy bruising and bleeding
- Diarrhea
- vomiting
- Lightheadedness
- Constipation
- Runny or stuffy nose
- Swelling of hands
- Tingling of the limbs
- precision medicine
The characteristics of multiple myeloma cells vary from person to person. Today, there are treatments that affect each person’s DNA and cause cancer treatment, in other words, personalization therapy.
- biological therapy: (immunomodulating agents)
Drugs in this category equip your immune system to fight multiple myeloma, modulate the behavior of cancer cells, and block the transmission and spread of cancer tissue to other areas.
- Thalidomide (Thalomid):
This drug was removed from the market due to fetal defects and is now only available for multiple myeloma. Constipation, intravascular clots, fatigue, and persistent neuropathies are side effects. This medicine is taken as a pill.
- Lenalidomide(Revlimid):
It has good therapeutic effects and its side effects are a decrease in blood platelets and a decrease in the body’s defense cells, in blood cells.
- pormalidomide(pomalyst):
This drug is also taken orally and causes less damage to the nerves than thalidomide, but the risk of intravascular clots in this drug is also high. Anemia and decreased white blood cell count are the side effects of this drug.
These drugs can increase the risk of other cancers.
The following two classes of drugs are among the newest treatments for multiple myeloma:
- nuclear export inhibitor:
The nucleus of the body’s cells is where our DNA is located and our genetic content. A protein called XPO1 is present in the cell, which transports nuclear proteins to other areas of the cell. By blocking this protein, these drugs block the release of cancer gene instructions.
Selinexor(Xpovio):
The drug is taken as a pill two days a week with an interval of three days, the reduction of platelets and white blood cells in the body, respiratory infections, loss of appetite and weight loss are some of the side effects of this drug.
Heston’s deacetylase inhibitors (HDAC)inhibit:
These drugs affect light-activated genes inside the cell. Histone is a protein on our
chromosomes.
panobinostat(Farydak):
This drug is a capsule that is taken orally for two weeks, three days a week and once a day. The patient stops the drug for one week and takes it again for two weeks according to the previous plan and this cycle continues.
Severe diarrhea, decreased blood cells, blood sodium and potassium disorders, and severe internal bleeding are some of the side effects of this drug.
- Chemotherapy:
Common treatments for multiple myeloma include drugs used in chemotherapy:
- Melphalan
- cylophosphamide(Cytoxan)
- etoposide(VP-16)
- doxorobicin
- lipsomal doxorubicin(Doxil)
- bendamustine(Treanda)
- Vincristin(Onvovin)
These drugs can usually be used in combination with dexamethasone or some immunomodulatory drugs (immunosuppressive drugs).
If a patient is a candidate for stem cell transplantation, the use of Melphalan will be prohibited because this drug can cause bone marrow damage.
Complications such as loss of appetite, mouth ulcers, nausea and vomiting and hair loss along with decreased platelet count, white blood cells and red blood cells are side effects of chemotherapy that are often temporary and resolve with the end of chemotherapy.
- Radiotherapy
For cases where the myeloma masses are localized, radiotherapy is used. Sometimes radiotherapy is used to relieve bone pain.
- bone marrow transplant
Finally, stem cell transplantation in multiple myeloma is now more successful than in the past due to advances in preparation techniques.
It should be noted that different combinations of the drugs mentioned above can be used at the discretion of the physician and according to the general health of the patient.