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Some patients with multiple myeloma have an early stage of the disease that does not produce any symptoms for years, referred to as asymptomatic. According to researchers at the MD Anderson Cancer Center, treatment for patients with asymptomatic multiple myeloma should be delayed until the detectable progression of cancer and/or symptoms of the cancer are exhibited in the patient.

Multiple myeloma is a cancer involving important immune (infection fighting) cells called plasma cells. Plasma cells aid the body in fighting infection by producing specialized proteins, called antibodies that have the ability of target and/or kill foreign cells. In multiple myeloma, cancerous plasma cells produce abnormal and excessive antibodies that do not have the ability to properly fight infection. In addition, the cancerous plasma cells accumulate in the bone marrow suppressing the normal formation and function of other cells that are necessary for normal production of blood cells and immune functions. In addition, the excessive accumulation of cancer cells in the bone marrow ultimately leads to the formation of tumors in the bone and the breakdown of bone.

Diagnosis of multiple myeloma includes the detection of proteins produced by the cancer cells, called M-proteins, which can be found in the blood or urine of persons with this cancer. Magnetic resonance imaging (MRI) is also used to identify the presence of tumors in the bone and/or the breakdown of bone. Most patients with multiple myeloma experience symptoms of the disease before diagnosis and require immediate treatment. However, some persons experience no symptoms and are diagnosed incidentally through screening tests, especially increased M-protein levels in the blood, which leads to the recognition of multiple myeloma. These patients may have asymptomatic multiple myeloma for years before treatment is required to alleviate symptoms and/or prolong survival. Approximately 15% of patients with multiple myeloma will be classified as asymptomatic.

Researchers from the MC Anderson Cancer Center compared the results of over 100 patients with asymptomatic multiple myeloma, who had received either early treatment while the cancer was still asymptomatic, or delayed treatment until the progression of cancer. Progression of multiple myeloma is usually defined as an increase in M-proteins in the blood by a specified amount or an increase in the size and number of tumors in the bone. The average survival time for both groups of patients was 5 years. Since there was no comparable difference between these two groups of patients, these physicians advised a delay of treatment for patients with asymptomatic multiple myeloma until there is a detectable progression of cancer.

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These physicians also reported that MRI scanning may be helpful in predicting which patients were at a higher risk for developing early progression of cancer. Patients at a high risk for early progression may benefit from early treatment for multiple myeloma, while the cancer is still not producing symptoms. Only future clinical trials will reveal the true benefit of early treatment for these patients. Individuals with asymptomatic myeloma should talk to their physicians about risk factors that would predict for early cancer progression or about the risks and benefits of participating in a clinical trial further evaluating detection methods for early progression or other promising new treatment strategies. (Blood, Vol 96, No 6, pp 2037-2044, 2000)

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