Managed Care - July 2008 - (Page H9) Multiple Myeloma: Epidemiology and Therapeutic Options JOSEPH M. TUSCANO, MD Associate Professor of Medicine, Department of Internal Medicine, Division of Hematology and Oncology University of California–Davis Cancer Center, Sacramento more than 10,000 deaths from the disease this year (ACS 2008). In the United States, approximately 45,000 to Myeloma remains an incurable disease, but 50,000 people live with this disease (ACS 2008). The most significant risk factor for multiple myeloma its management has significantly improved is age; the median age at diagnosis is 70 and the disease is with the introduction of novel treatment rarely diagnosed in individuals younger than 45 (Ries agents. Variations in both disease manifesta2007). The current 5-year survival rate is estimated to be tion and patient response to treatment have approximately 34 percent, with a significantly higher rate personalized approaches to care. found among younger patients (ACS 2008). Survival rates for myeloma patients have been steadily increasing and this trend is expected to continue throughout this decade. Multiple myeloma (or simply myeloma) is an incurMyeloma is nearly twice as common among African able cancer of plasma cells that results in significant disAmericans as European Americans, and more common in ruption of the bone marrow microenvironment, along men than women (Ries 2007). Data also suggest with the destruction and invasion of surroundthat environmental factors, such as exposure to ing bone. This typically progressive disease chemical toxins or ionizing radiation, may play currently accounts for approximately 10 to 20 a role in the development of this disease, as may percent of hematologic cancers and approxiimmune system disorders (Durie 2007). mately 1 percent of all cancers (Ries 2007). As When myeloma was first identified, the diswith most other hematologic cancers, it curease was attributed to the malignant transforrently is regarded as a chronic incurable dismation of a single plasma cell, with related ease, although recently developed, highly effecmorbidity almost entirely the consequence of tive therapeutics hold great promise for the uncontrolled growth of myeloma cells. Curpatients with this disease. rently, the disease is more accurately characterJOSEPH M. ized as a microenvironmental disorder. ReEpidemiology and pathogenesis TUSCANO, MD search has shown that both the proliferation In the United States, the annual incidence of and survival of myeloma cells, along with their ability to myeloma is approximately 4 cases per 100,000 individdevelop resistance to various drugs, are greatly influuals, and the American Cancer Society (ACS) estimates enced by their immediate surrounding environment that there will be about 20,000 new cases of myeloma and (Mitsiades 2007). The microenvironment of surrounding myeloma cells Joseph M. Tuscano, MD, received his medical degree from the consists of extracellular matrix proteins, bone marrow University of Southern California School of Medicine. He stromal cells (BMSCs), osteoblasts, osteoclasts, and variconducted his internship and residency at the University of ous cytokines, among other components. The interaction California–Davis Medical Center, and had a fellowship in of myeloma cells with BMSCs by means of adhesion oncology at the National Institutes of Health. His specialty molecules is of particular importance in the pathogenareas include bone marrow transplantation with high-dose esis of myeloma; once myeloma cells adhere to BMSCs, chemotherapy for metastatic breast cancer, lymphoma, chemical messengers and growth factors called cytokines leukemia, testicular cancer, and multiple myeloma. He reare released, which stimulate the growth of myeloma searches signal transduction, notably in human B-cell macells and prevent apoptosis. The release of a variety of lignancies, and has identified a signal cascade implicated in cytokines, most importantly interleukin (IL-) 6, also chronic myelogenous leukemia. He also is looking at other contributes to angiogenesis (the growth of new blood proteins thought to affect lymphoma. SUMMARY SUPPLEMENT / HEMATOLOGIC CANCER 9
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