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Thirteen thousand Americans are diagnosed with multiple myeloma every year. Incidence of this disease increases with age, with the median age of patients being 65 years. However, until just recently Medicare did not cover any finances involving the most effective treatment for this disease, high-dose chemotherapy followed by an autologous stem cell transplantation. Since most patients are older, the impact of Medicare’s non-coverage policy affected thousands of persons suffering from multiple myeloma, leaving many unable to pay for treatment proven to increase overall survival.

Controlled clinical studies have repeatedly demonstrated that high-dose chemotherapy and autologous stem cell transplantation (SCT) produces superior remission rates and significantly prolongs a patient’s duration of survival when compared to conventional chemotherapy for patients with multiple myeloma. High-dose chemotherapy and autologous SCT have become a standard of care for treatment of younger patients with multiple myeloma due to it’s proven superior effectiveness. Unfortunately, patients over 65 years historically were not offered this treatment because of the increased side effects thought to occur in older patients. Repeated studies, however, have demonstrated that patients over 65 years with multiple myeloma experience the same benefits from high-dose chemotherapy and autologous SCT as younger patients. Moreover, advancements in supportive care have markedly improved the safety of delivering high-dose chemotherapy, and toleration of treatment in older patients is comparable to that in younger patients.

Multiple myeloma is a cancer involving certain immune cells in the body. High-dose chemotherapy kills more of these cancer cells than conventional chemotherapy, but unfortunately kills more healthy cells in the body, such as stem cells. Stem cells are immature cells that eventually develop into the different types of blood cells. When stem cell levels are depleted, side effects such as anemia, bleeding and infection may occur. The treatment strategy utilizing stem cell transplantation is an attempt to restore the blood producing stem cells after high-dose therapy has reduced them to low levels. During an autologous stem cell transplant, the patient’s own stem cells are collected from circulating blood before chemotherapy treatment, frozen, and infused back into the patient after treatment to restore levels to normal.

After reviewing extensive medical literature, the Health Care Financing Administration (HCFA) supported a decision on August 29, 2000 that requires Medicare to pay limited coverage for multiple myeloma patients receiving high-dose chemotherapy and autologous SCT, effective October 1, 2000. Thousands of older patients on Medicare with multiple myeloma will now be able to benefit from the delivery of optimal treatment including high-dose chemotherapy and autologous stem cell transplantation. Persons with multiple myeloma who have Medicare should speak to their doctor about the risks and benefits of treatment with high-dose chemotherapy and autologous stem cell transplantation.

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