New treatment drastically helps cancer patients

Huntsman Institute uses an aggressive one-two punch of chemo and autologous stem cell transplant
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The six compressed vertebrae in Joyce Wise's back are what eventually led to her multiple myeloma diagnosis.

The 62-year-old Idaho Falls, Idaho, woman had never heard of the disease, a type of cancer that begins in the plasma cells in bone marrow and causes bone pain, leads to kidney failure and cripples the immune system.

Her prognosis was bleak: two to four years, at best.

But Wise is determined to beat the odds. And through a new treatment program at the Huntsman Cancer Institute that has been shown to increase multiple myeloma patients' median survival to 10 years from 2 1/2 years, she just might.

Guido Tricot, who recently left the University of Arkansas to become director of the Utah Blood and Marrow Transplant and Myeloma Program, has developed an aggressive treatment regimen aimed at knocking out myeloma cells and minimizing their ability to become resistant to drugs.

It's a one-two punch of intensive chemotherapy coupled with an autologous stem cell transplant, which involves collecting a patient's own healthy bone marrow cells beforehand, then replacing them. The combination is repeated and followed up with two years of maintenance treatment.

The idea, Tricot said, is to kill as many myeloma cells as possible before starting patients on maintenance drugs.

Chemotherapy, he explained, only targets myeloma cells that are actively dividing - not ones that are "sleeping," or out of cycle.

"Ultimately what you want to do is wake up all of the last 'sleeping' cells, make [them] start to divide and be killed by the chemotherapy," he said. "This takes a long time. And the problem with most of the treatments is they're too short and not intensive enough."

Killing the most myeloma cells possible gives patients a better chance of responding to newer drug therapies such as Thalomid and Revlimid, which work by attacking both the myeloma cells and the abnormal microenvironment in the bone marrow in which they flourish, Tricot said.

This approach, which has been used on more than 5,000 patients since Tricot and his colleagues at the University of Arkansas began studying it in 1990, puts about 80 percent of patients in complete remission for an average of five years.

Once patients relapse, the treatment is repeated, helping many see remission again.

"At least half of patients are expected to survive more than 10 years," Tricot said.

Tricot said two important factors seem to determine who responds best to the treatment: the genetic make-up of the myeloma cells and how much the disease has spread.

"The worst combination is bad genes and lots of disease," he said.

Chromosome studies, including fluorescence in situ hybridization, or FISH, and gene array analysis, help doctors better understand a patient's particular kind of multiple myeloma.

There are at least seven different types of the disease, "ranging from very good to very bad," Tricot said. About 10 percent of patients have the worst, or most aggressive, kind.

The next step to improve treatment for myeloma patients, Tricot said, will be basic research to identify which myeloma cells aren't killed by the treatment and why.

In the meantime, the hematologist hopes the treatment will prolong his patients' lives until the next, better drug therapies are made available. About 30 drugs are in development.

"We don't know which ones are the winners or losers at this time," he said, "but I know for sure in three to five years we'll know."

* The five-year survival rate for people with multiple myeloma is only 32 percent - one of the lowest of all cancers.

* About 16,000 people in the U.S. are diagnosed with the disease each year; about 50,000 are currently living with the disease. An estimated 10,790 will die this year.

* Two-thirds of people diagnosed with multiple myeloma are older than 65. The disease is uncommon in people younger than 40, though recent statistics suggest the incidence is increasing - and at an earlier age.

* Men are twice as likely as women to develop multiple myeloma; the disease is twice as common in blacks as it is in whites.

Source: Huntsman Cancer Institute