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Will salvage therapy help in treating multiple myeloma??

Multiple myeloma (MM) is a plasma cell cancer. Plasma cells (type of B-lymphocytes), are present in the bone marrow and they play a crucial role in the immune system. These plasma cells produce specific antibodies (immunoglobulins) when a foreign body attacks the body. In multiple myeloma, these cells become malignant, proliferate uncontrollably, and create an aberrant protein called M-protein, which is responsible for the disease symptoms [1].


What are the current treatment options for MM?


Types of conventional treatment for multiple myeloma include:

  • Targeted therapy: Targeted therapies concentrate on particular defects in cancer cells. These therapies can kill cancer cells by preventing the aberrations.

  • Immunotherapy: The patient’s immune system is used in immunotherapy to combat cancer. But the cancer cells have the ability to create proteins that aid in their protection from host immune system cells. Immunotherapy attacks these proteins and helps the host immune system to fight cancer.

  • Chemotherapy: Drugs like cyclophosphamide, doxorubicin, and etoposide can be used to kill cancer cells in multiple myeloma. Before proceeding with a bone marrow transplant in MM, chemotherapy should be given to necrotize the cancer cells.

  • Corticosteroids: Corticosteroids regulate the immune system to control the inflammation in multiple myeloma.

  • Bone marrow transplant: A bone marrow transplant which is otherwise called a stem cell transplant can be done in multiple myeloma by taking a part of the healthy bone from any other part of the body and placing it in the diseased area.

  • Radiotherapy: High-powered energy beams from sources like X-rays and protons are used in radiation treatment to kill cancer cells. It is used to shrink the myeloma cells in MM.

  • All these treatments can be used alone or in combination depending on the severity and extent of the disease [2].


What is salvage therapy?


Salvage therapy is another name for rescue therapy. Salvage therapy is not a particular medical procedure or drug. It refers to the therapies offered to patients who are unable to withstand or have not responded to conventional treatments. Various forms of salvage therapy can be used, depending on the patient and their general health status..


Multiple Myeloma

Salvage therapy typically consists of drugs that causes minimum side effects than prior therapies. Additionally, salvage therapy may involve taking experimental drugs or drugs being tested in studies for a particular illness. Salvage therapy can also be referred to as radiotherapy in failed chemotherapy cases. Initially, this term is used to describe only treatments for HIV and cancer. But now, this phrase is also used as a last resort against numerous progressive diseases. A few examples are renal end artery disease which does not respond to dialysis and multiple myeloma which does not respond to conventional treatment [3].


How does salvage therapy effect mm?


Salvage therapy ought to be the same for everyone. However, each patient is unique in multiple myeloma, so care must be customized to them. The disease features and prior treatments, such as line of treatment, relapsed or refractory disease, and the aggressiveness of the relapse must be taken into account. According to the literature, with a once-in-a- week dose regimen, carfilzomib, pomalidomide, and dexamethasone are highly effective combinations of salvage chemotherapy for treating relapsed/refractory multiple myeloma. Radiotherapy can be used in cases where this combination therapy fails depending on the age and the condition of the patient. Recent studies emphasize that newer drugs like immunomodulatory drugs , monoclonal antibodies, and proteasome inhibitors can also be given in the form of salvage therapy if all other conventional drugs and radiotherapy fail [4].


Fight the fight, find the cure!


An early and accurate diagnosis will help in increasing the success rate of treatment for multiple myeloma. Conventional chemotherapy, radiotherapy, bone marrow transplant (if required) and salvage therapy in refractory/recurrent cases are the effective treatment strategies that are currently available for multiple myeloma. Further studies are required to know the efficacy of newer drugs in recurrent cases.


References


1. J. Silberstein, S. Tuchman, and S. J. Grant, What Is Multiple Myeloma?,” JAMA, vol. 327, no. 5, p. 497, Feb. 2022, doi: 10.1001/jama.2021.25306.

2. The Diagnosis and Treatment of Multiple Myeloma - PMC.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973001/ (accessed Feb. 07, 2023).

3. R. Sv, “Multiple myeloma: 2022 update on diagnosis, risk stratification, and management,” American journal of hematology, vol. 97, no. 8, Aug. 2022, doi: 10.1002/ajh.26590.

4. C. Aj et al., “Diagnosis and Management of Multiple Myeloma: A Review,” JAMA, vol. 327, no. 5, Feb. 2022, doi: 10.1001/jama.2022.0003.

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Collaborators

IIT Guwahati
University of Manchester
Rhenix Lifesciences
American university of Sharjah
IIT Delhi
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