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Refractory Plasma Cell Neoplasm
Current Clinical Trials
There are two main types of refractory myeloma patients:
- Primary refractory
patients who never achieve a response and progress while still on induction
chemotherapy.
- Secondary refractory patients who do respond to induction
chemotherapy but do not respond to treatment after relapse.
A
subgroup of patients who do not achieve a response to induction chemotherapy have stable disease and enjoy a survival prognosis that
is as good as that for responding patients.[1,2] When the stable nature of the
disease becomes established, these types of patients can discontinue therapy until the
myeloma begins to progress again. Others with primary refractory myeloma and
progressive disease require a change in therapy; the options appear in the previous section on Multiple Myeloma Treatment Options.
The myeloma growth rate, as
measured by the monoclonal (or myeloma) protein-doubling time, for patients who respond to their initial therapy, increases progressively with each
subsequent relapse and remission durations become shorter and shorter. Marrow
function becomes increasingly compromised as patients develop pancytopenia and
enter a refractory phase; occasionally the myeloma cells dedifferentiate and
extramedullary plasmacytomas develop. The myeloma cells may still be sensitive
to chemotherapy, but the regrowth rate during relapse is so rapid that
progressive improvement is not observed.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with refractory multiple myeloma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Riccardi A, Mora O, Tinelli C, et al.: Response to first-line chemotherapy and long-term survival in patients with multiple myeloma: results of the MM87 prospective randomised protocol. Eur J Cancer 39 (1): 31-7, 2003.
[PUBMED Abstract]
-
Durie BG, Jacobson J, Barlogie B, et al.: Magnitude of response with myeloma frontline therapy does not predict outcome: importance of time to progression in southwest oncology group chemotherapy trials. J Clin Oncol 22 (10): 1857-63, 2004.
[PUBMED Abstract]
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