VI. PROGNOSIS/CLINICAL COURSE

Although many effective therapies are available at this time, myeloma is considered to be an incurable disease. With appropriate therapy, median survival is 3-4 years. Patients undergoing an autologous stem cell transplant often survive for more than 5 years. However, the overall 5-year survival for multiple myeloma is only 33% (SEER).

The first decision the clinician must make is whether the patient is a candidate for high-done chemotherapy with autologous stem cell transplantation. Patients who can tolerate a transplant will undergo high dose chemotherapy (with the alkylator melphalan) followed by an autologous stem cell transplant.

This patient is not a good candidate for an autologous stem cell transplant because of the renal failure. She would best be treated with dexamethasone and/or thalidomide. These are widely used as initial therapy and can achieve a response in 70% of patients. Lenalidomide (Revlimid) is a thalidomide derivative with fewer side-effects than thalidomide that can achieve response even in thalidomide-resistant cases.

Initial therapy for otherwise healthy patients in multiple myeloma is evolving rapidly with the advent of thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade).

Bortezomib is highly effective in relapsed disease. Unfortunately, as mentioned above, all patients will likely experience disease relapse, and novel agents are actively being investigated.

The patient was treated with high-dose dexamethasone. She showed improvement, but subsequently died of renal complications.