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    Robust multiple myeloma treatment program holds promise


    MHE: What are the promising developments in multiple myeloma?

    DhakalDhakalDhakal: Significant progress has been made in the field of MM over the last decade, and this has translated into a three- to four-fold increment in the median survival.  In 2015, we have four new drugs approved for the disease including the monoclonal antibodies.  The disease diagnostic criteria have been revised and the former high-risk smoldering myeloma is now considered multiple myeloma needing treatment. Stringent response criteria including the minimal residual disease has been incorporated in the response guidelines and will soon be used in the clinical trials. Understanding clonal progression, evolution, and tides has helped both in elucidating the disease behavior and expanding the therapeutic choices.  With the introduction of both the proteasome inhibitor and the immunomodulator as a standard induction treatment, we have achieved an unprecedented response rates. Studies exploring the role of ASCT in the context of modern induction regimens have shown that high-dose therapy is associated with superior response rates and progression free survival.  

    Evolving paradigms in the treatment of multiple myeloma include newer promising immune approaches, such as adoptive cellular therapies, vaccines, or antibody-based immune manipulations. Though multiple myeloma is still considered incurable, it is clear that improved understanding of disease biology and clonal architecture of relapse combined with the availability of multi-targeted approaches, we are ever closer to a lasting cure or transformation into indolent and long-lasting disease courses or both.

    MHE: What are healthcare executives’ major challenges in the area of multiple myeloma?

    Hari: The single most important challenge for healthcare executives in this area is the increasing of cost of care. Newer therapeutics have changed the outcome for patients dramatically with average survival doubling in the past decade. However, the paradigm of care involves continuous therapy with targeted medications. The annual average cost of care even in patients maintaining a remission can exceed $100,000, while the cost of care for relapsed myeloma could be three to four times higher. Getting to a model of affordable care without compromising the quality of care or rationing therapies is a challenge.

    Other issues include maintaining quality of life of survivors and maintaining standards of care for the majority of patients. It has been shown that the utilization rate for autologous transplant for myeloma even among transplant eligible patients is less than 50%, and that minorities are especially likely to not receive such therapy.

    Next: How can we meet these challenges?



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