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Wednesday, 4 December 2013

Multiple myeloma – Treatments for relapsed or treatment-resistant multiple myeloma In conventional medicine perspective

Multiple myeloma. also known as plasma cell myeloma or Kahler’s disease, is a types of abnormal growth of plasma cells collected in the none marrow where they grow and multiple to interfere with the production of normal blood cells. Paraprotein, an abnormal antibody produced by the plasma cell myeloma not only can cause kidney problem but also interference with the Roche automated total bilirubin assay caused by precipitate formation of that can cause clinical confusion, according to the study by the Harvard Medical School, Boston(1). Other study indicated that the production of paraproteins caused spurious results on individual analytes including total bilirubin (TBIL), direct bilirubin (DBIL), or HDL-cholesterol (HDL-C)(b). there is also a report of a 50 years old
chloride resistant metabolic alkalosis in a patient with hypercalcemia related to Multiple Myeloma (MM)(c).
VI. Treatments
A. In conventional medicine perspective
A.3. Treatments for relapsed or treatment-resistant multiple myeloma
According to the study to estimate the efficacy of thalidomide monotherapy in the treatment of refractory and relapsed cases of multiple myelomaby Katedry i Kliniki Hematologii i Transplantacji Szpiku Kostnego Slaskiej Akademii Medycznej w Katowicach, found that the good tolerance of the drug, especially in lower doses, and lack of myelosuppression effect allows to expect, that the combination of thalidomide with other cytostatic drugs will improve the efficacy in patients with refractory or relapsed myeloma(59).
Other study in an assessment to compare the costs of two recent treatments (bortezomib (BORT) and lenalidomide plus dexamethasone (LEN/DEX)) for relapsed/refractory multiple myeloma (rrMM), from the perspective of a United States (US) payer, found that drug costs for the treatments were very similar, differing by under $10 per day. Medical and AE management costs for BORT were higher by more than $40 per day. Treatment with BORT had annual excess total costs of >$17,000 compared with LEN/DEX. A cost advantage for LEN/DEX was maintained across a variety of sensitivity analyses. Total cost per month without progression was 11% lower with LEN/DEX. rrMM treatment with BORT and LEN/DEX had comparable drug costs, total treatment costs for BORT were higher due to ongoing direct medical and AE management costs. Total costs per outcome (a month without disease progression) were lower for LEN/DEX, according to the study by Cedars-Sinai Samuel Oschin Cancer Center(60).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/12521367
(b) http://www.ncbi.nlm.nih.gov/pubmed/18251580
(c) http://www.ncbi.nlm.nih.gov/pubmed/22073517
(59) http://www.ncbi.nlm.nih.gov/pubmed/14526479
(60) http://www.ncbi.nlm.nih.gov/pubmed/23281721