Biology and treatment of multiple myeloma Journal Article
| Authors: | Niesvizky, R.; Siegel, D.; Michaeli, J. |
| Article Title: | Biology and treatment of multiple myeloma |
| Abstract: | The uniformly fatal plasma cell malignancy, multiple myeloma (MM), currently represents 10-15% of hematologic neoplasms in the USA and has been steadily increasing in incidence for several decades. Therapeutic alternatives have lagged significantly behind insights into the biology and pathogenesis of this entity. Traditionally felt to be a neoplasm of fully differentiated plasma cells, evidence has been mounting that the self renewing population consist of cells derived from a much earlier compartment; perhaps prior to B-cell lineage commitment or even at the level of an earlier 'stem cell'. Bcl-2 protein overexpression has been almost uniformly seen in both clinical myeloma specimens as well as in myeloma cell lines. The failure to consistently identify the t(14;18) translocation, normally found in follicular lymphomas and characteristically associated with overexpression of bcl-2, implies a unique mechanism in MM. A number of cytokines, including TNFα, IL-1 and IL-6 have been found to play a central role not only in the biology of the malignant clone but have been shown to prevent programmed cell death, this may be the unifying event in MM. Standard therapy for MM has been an alkylating agent and corticosteroid. Combination chemotherapy provides more prompt palliation but no clear survival advantage. In advanced stages, adriamycin may offer some survival advantage. High dose chemotherapy with or without stem cell support offers a potentially curative therapeutic approach. New interventions directed at the complex cytokine networks pertinent to the pathogenesis of MM are an exciting new area of investigation. Identification of new prognostic parameters as well as new active agents remains the central theme in clinical myeloma research. © 1993. |
| Keywords: | adult; aged; survival analysis; proto-oncogene proteins; prednisone; clinical feature; review; salvage therapy; cisplatin; doxorubicin; cancer combination chemotherapy; disease classification; cytarabine; cancer staging; cancer palliative therapy; cell death; cell division; carboplatin; apoptosis; multiple myeloma; gene expression; bone marrow suppression; etoposide; antineoplastic combined chemotherapy protocols; incidence; morbidity; neoplasm proteins; tumor markers, biological; risk factors; cytogenetics; alkylating agent; cyclophosphamide; dexamethasone; melphalan; steroid; vincristine; plasmacytoma; cell renewal; drug resistance; carmustine; stem cell; survival time; prednisolone; cytokine; cytokines; tumor necrosis factor alpha; gamma interferon; tumor cell line; pentoxifylline; interleukin 6; remission induction; recurrent disease; methylprednisolone; chromosome aberrations; corticosteroid; follicular lymphoma; proto-oncogene proteins c-bcl-2; retinoic acid; pentostatin; multidrug resistance; cladribine; interleukin 1; middle age; myeloma cell; biological response modifiers; cell kinetics; interleukin 1 receptor; chromosome translocation 14; peptichemio; prognosis; human; male; female; chromosome translocation 18 |
| Journal Title: | Blood Reviews |
| Volume: | 7 |
| Issue: | 1 |
| ISSN: | 0268-960X |
| Publisher: | Churchill Livingstone |
| Date Published: | 1993-03-01 |
| Start Page: | 24 |
| End Page: | 33 |
| Language: | English |
| DOI: | 10.1016/0268-960x(93)90021-u |
| PUBMED: | 8467229 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
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