Regarding the article on the pending redefinitions for multiple myeloma (11/25/13), I am taking the liberty to comment as I dedicated time to redefinition and treatment of multiple myeloma.
Disease outcome in multiple myeloma has in the past 10 years improved, but the disease-free and overall survival curves have not flattened, and only patients who receive allogeneic transplantation may be cured.
Two staging systems have been used: the Durie Salmon staging and the International Staging System. These staging systems address only symptomatic multiple myeloma, but not the earlier stages of the disease.
Reading the article in OT, brought to mind an abstract I worked on and submitted but that was not published. The results section stated: “Stages for multiple myeloma were defined and the conclusion is that eradicative therapy needs to be administered much earlier and that symptomatic multiple myeloma is comparable with stage IIIB and IV breast cancer, which explains the high risk of relapse and the low probability of cure in multiple myeloma.”
The proposed “Staging for Multiple Myeloma” starts with stage I rather than IIIB and is based on the observation that the bone marrow contains under normal circumstances less than one percent plasma cells (Blood 1990;76:1739-1737). The table shows multiple myeloma fitted into a TNM format.
The abstract compared the stages with stages defined for breast cancer in the TNM guide of 1990. I believe, though, that the staging presented in the abstract requires consideration and I share my considerations. Staging requires further consideration.
There are methods of treatment in a program for the different stages worked on last year that may be of interest to investigators. They are welcome to send me an email to receive the information.
MARLIES VAN HOEF, MD, PHD, MBA
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