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Medical Edge Newspaper Column from Mayo Clinic
MULTIPLE MYELOMA: EXTENDING PATIENTS’ LIVES
DEAR MAYO CLINIC: Is thalidomide now approved for use in patients with multiple myeloma? My father took it “off label” several years ago and had a very good result. Are there other treatment options for this disease?
ANSWER: Despite thalidomide’s notorious past — having caused numerous cases of severe birth defects when used by pregnant women — the drug is making a comeback as treatment for several conditions.
One of them is multiple myeloma, a cancer of the bone marrow’s plasma cells. Abnormal versions of these cells proliferate, leading to anemia, immune deficiency, weakened bones, kidney problems and other symptoms.
At present, there is no cure for multiple myeloma, but we are steadily adding treatments that lengthen patient survival time and improve quality of life. Until recently, conventional chemotherapy was our only option, and drugs were limited to two types: alkylating agents (such as melphalan and cyclophosphamide) and corticosteroids (prednisone and dexamethasone). These drugs kill abnormal plasma cells, called myeloma cells. But now our arsenal is being supplemented by other medications such as thalidomide, bortezomib and lenalidomide, which target the myeloma cells as well as the microenvironment that nurtures them. For example, the new drugs may suppress the blood supply or growth factors on which the abnormal cells depend. As a result, we are achieving greater success rates, especially when new and conventional drugs are used in combination.
A recent large French study showed that adding thalidomide to standard chemotherapy prolonged survival in multiple myeloma. In another study, my colleagues and I found that average time to progression was more than twice as long in patients on thalidomide and dexamethasone compared to those on dexamethasone alone. Thus they enjoyed longer periods of being relatively symptom-free. The FDA recently approved thalidomide in combination with dexamethasone for treatment of newly diagnosed multiple myeloma.
New options don’t necessarily displace old treatments but can be additive and even synergistic. We are now planning three-drug trials and look forward to four-drug trials. The individual agents, by themselves, are not panaceas, but in combination they lengthen survival. Our hope is to find the ultimate combination — from currently available drugs as well as newer ones now being tested — that will indeed constitute a cure for multiple myeloma.
— S. Vincent Rajkumar, M.D., Hematology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Multiple Myeloma
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More Information on Multiple Myeloma
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READERS: Gum disease, not dental cavities, is the primary cause of adult tooth loss. And the bad news is that 95 percent of people over age 65 have some form of gum (periodontal) disease.
That grim statistic doesn’t mean that you’re destined for dentures, according to Mayo Clinic Women’s HealthSource. Proper oral hygiene and good professional care will not only keep your smile healthy but may also help protect your heart and other vital organs.
Periodontal disease begins with plaque, which is made up of bacteria and sticky bacterial products that accumulate on your teeth within hours after brushing. When not removed, plaque builds up and is visible as a soft film on your teeth. If you don’t regularly remove the film, hard mineral deposits called tartar or calculus collect below the tooth line. The bacteria in the plaque then begin to produce toxins that irritate the gums and supporting bones. This is gingivitis, the early and mildest form of periodontal disease.
Left untreated, the gums separate from the teeth, forming pockets that harbor even more bacteria — and bigger problems. Advanced gum disease, called periodontitis, may lead to the loss of teeth. Harmful bacteria can travel to major organs, such as the heart, and establish new infections.
The best treatment is prevention.
Brush your teeth twice a day, or as often as recommended by your dentist. Brush for at least two minutes with fluoride toothpaste and a soft-bristle brush. Most studies have shown that electric toothbrushes are better at removing plaque than are standard toothbrushes, perhaps because people don’t use an optimal technique or brush long enough. Floss daily to remove food particles and plaque.
If you develop red, puffy or bleeding gums — the first sign of gingivitis — see your dentist. If treated early, gingivitis is reversible and does not necessarily worsen.
Additional Resources:
Periodontal (Gum) Disease
Appointment Information
More Information on Periodontal Disease
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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