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Multiple Myeloma at the 19th Congress of the European Hematology Association: What is New?
Multiple myeloma (MM), a proliferation (growth) of malignant plasma cells in the bone marrow destroying bones, accounts for 10% of all hematologic malignancies.
Approximately 45.000 new cases are diagnosed each year together in the US and Europe. MM is mainly a disease of elderly people with age at diagnosis between 65-70 years.
During the meeting, recently developed approaches for diagnosis and monitoring will be presented. Gene-expression-profiling to detect molecular subgroups with a different prognosis and high-throughput-sequencing to identify new genetic lesions will be discussed. These new technologies in concert with modern means of immunophenotyping are used to detect “Minimal Residual Disease”, the relatively few cancer cells that have survived treatment and are responsible for the reoccurrence of the disease. This directly relates to fine tuning of treatment strategies. Finally, imaging modalities such as MRI- or PET / CT scanning are very useful to detect (occult) bone disease before symptoms such as pain / fractures occur.
Since the introduction of novel agents it has become clear that the median overall survival of elderly patients has doubled from 30 to 60 months. This was achieved by adding the immune-modulator thalidomide or the proteasome inhibitor bortezomib to standard chemotherapy with melphalan and prednisone. It is probable that the relatively non-toxic oral regimen of lenalidomide in combination with low-dose dexamethasone will become the standard of care. The addition of monoclonal antibodies directed towards the malignant plasmacells, as well as histone deacytelase inhibitors are currently being explored. In younger patients a variety of new agents is also being tested in conjunction with more aggressive chemotherapy and autologous stem cell transplantation. As we will explain, during the congress, the survival of patients with MM continues to improve and the possibility of cure is being considered.
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