The Indian Council of Medical Research (ICMR) has issued a consensus document for management of multiple myeloma to assist the oncologists in making major clinical decisions encountered in managing their patients.
Senior officials in the ICMR said that this consensus statement represents the ICMR’s current thinking on the topic based on available evidence. This has been developed by national experts in the field and does not in any way bind a clinician to follow this guideline verbatim. The physician can use an alternate mode of therapy based on the discussions with the patient and with reference to institution, national or international guidelines. The mention of pharmaceutical drugs for therapy does not constitute endorsement or recommendation for use but is a guidance for clinicians in complex decision-making.
This consensus statement may be used as framework for more focused and planned research programmes to carry forward the process. The aim of the ICMR consensus document is to assist oncologists in making major clinical decisions encountered in managing their patients, well realising the fact that some patients may require treatment strategies other than that suggested in these guidelines.
The initiative of the ICMR in this regard is significant as the multiple myeloma is the second most common haematological malignancy after non Hodgkins lymphoma and it accounts for 15 per cent of all haematological malignancies.
Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. It’s the most important of the class of diseases included under the plasma cell dyscrasias.
The incidence of this disease increases with age in a spectrum of 4/lakh in the general population to around 30/lakh in over 25 years population. Even though lots of advancements have been made in the pathogenesis and etiology of this disease, it has still not made its way into the category of curable diseases.
Chemotherapy remains as the mainstay of treatment. Initially successfully started with melphalan, which incidentally still remains to be the main stay of therapy, other agents like cyclophosphamide, vincristine, doxorubicin, and others have also been tried. With the advent of bone marrow transplant and stem cell transplant, these have taken up an important place in the treatment protocols.
But still, chemotherapy or induction therapy is essential before and later for transplant eligible and only therapy for transplant ineligible. Better awareness regarding the pathogenesis of myeloma, the marrow micro environment and the myeloma cell—marrow stromal cell interactions, have led to newer drugs coming up with better results. Latest among these being the immunomodulatory drugs like Thalidomide and Lenalidomide, the proteasome inhibitors like Bortezomib and their congeners. Many more are in various phases of research.