Maintenance therapy is relatively low-intensity treatment (low relative to therapy of active disease - and low in terms of dose and/or frequency) delivered after full-intensity treatment (which may include stem cell transplantation). The purpose is to keep the disease under control for a longer time than would be the case without maintenance therapy. In selected cases, it may reduce the disease burden and/or improve survival. It usually comprises a single drug such as lenalidomide, bortezomib, thalidomide, or steroids (dexamethasone, prednisone, methylprednisolone) - but may include more than one drug. It may be given for a set period of time, but is more usually given until the disease relapses or there is toxicity.

In the last decade there has been an explosion of new therapies for myeloma, including novel immunomodulatory agents such as such as Thalidomide and Lenalidomide (Revlimid™) as well as drugs such as Bortezomib (Velcade™) that attack “housekeeping” processes in cancer cells. There are now 40 agents being tested in myeloma and over a hundred active clinical trials. Intravenous medications to decrease the risk of fractures in myeloma patients are given on a monthly basis, but because of a variety of side effects, ongoing clinical trials are focused on limiting patient exposure to these medications while maximizing effectiveness. The two most exciting upcoming treatments target specific cell surface markers using antibodies against surface proteins (such as CD38) and cell therapies, such as the CD19 targeted chimeric antigen receptor therapy reported worldwide in summer 2011 for three patients with chronic lymphocytic leukemia (CLL).

If the patient does not demonstrate CRAB criteria (see below), then treatment is not needed. If patient’s demonstrate CRAB criteria, then some treatment is needed. The caveat is that patients that demonstrate a single area of bony destruction as their only CRAB criteria yet still demonstrate a bone marrow with myeloma cells can betreated with radiation therapy to that single bony area and then followed closely for the development of additional CRAB criteria.

CRAB criteria:
· Calcium -- eating away at your bones and spitting the calcium into your blood, causing high calcium levels that can damage your kidneys and make it hard for you to function

· Renal - myeloma cells can make malformed antibodies that when they are filtered through your kidney, damage your kidney, and some untreated myeloma patients show up in the ER with kidney failure for no clear cause and require dialysis that day

· Anemia - too many myeloma cells in your bone marrow make it difficult for you to make an adequate number of red cells, causing you to be anemic, feel more tired, and eventually you can be so anemic that you are predisposed to suffer a heart attack or stroke

· Bones - myeloma cells can eat away at your bones and put you at high risk of fracture – often times in your hips, pelvis, or back (in your back, these are called compression fractures).

In our larger bones we have bone marrow, the area in the center of each bone where white cells, red cells, and platelets grow. Multiple myeloma occurs when one type of white blood cell, a plasma cell, reproduces without stopping and causes damage to other organs. In most patients, myeloma is found in more than one location and is called multiple myeloma. Normally these cells would create a wide variety of antibodies to support our immune system; instead the cancerous plasma cells take up more and more room in the bone marrow cavity, which leaves less and less room for normal marrow cells that make other white cells and red cells. Without these red cells in the blood, patients develop symptomatic anemia with fatigue most commonly.

Instead of millions of different antibodies that can effectively protect the patient from infection, myeloma cells make only one type of antibody and thus leave the patient vulnerable. These myeloma cells can also push their way into the hard outer layer, the cortex, of bones and this can make those bones particularly prone to break. In fact many people realize they have multiple myeloma when they break a bone from minimal activity such as bumping into something or picking up a gallon of milk.

Additionally, myeloma cells can make so many antibodies or misshapen antibodies that they clog the kidney’s filtration system and can cause permanent kidney damage that, left untreated, can lead a patient to dialysis.

For patients with newly diagnosed multiple myeloma, the cells in the bone marrow that are cancerous are plasma cells -- these are white cells where 80% of their job is to make antibodies (antibodies are proteins). We follow the protein products of these myeloma cells to figure out how many myeloma cells are in the patient's body, and basically if treatment is working or not. In a newly diagnosed patient, this whole process started 2-20 yrs prior to diagnosis (60% > 10 yrs), when one or a group of plasma cells mutated to not die. Then this mutated plasma cell had kids, those kids had kids, and eventually you had a couple billion mutated plasma cells floating around BUT they were kept "caged" by your immune system. These cells were abnormal, they can be detected, and they lived with you without hurting you. This is called MGUS - Monoclonal Gammopathy of Undetermined Significance. Over time your immune system became weaker, and let the cage for these mutated plasma cells get bigger -- this is called Smoldering Myeloma. While this is an oversimplification of the process, patients with MGUS and Smoldering Myeloma are not significantly symptomatic.

The important transition is between smoldering myeloma and active myeloma. This requires an important clinical transition when these mutated cells prove they are trying to kill you. Myeloma cells try to hurt patients in some basic ways:

· Calcium -- eating away at your bones and spitting the calcium into your blood, causing high calcium levels that can damage your kidneys and make it hard for you to function

· Renal - myeloma cells can make malformed antibodies that when they are filtered through your kidney, damage your kidney, and some untreated myeloma patients show up in the ER with kidney failure for no clear cause and require dialysis that day

· Anemia - too many myeloma cells in your bone marrow make it difficult for you to make an adequate number of red cells, causing you to be anemic, feel more tired, and eventually you can be so anemic that you are predisposed to suffer a heart attack or stroke

· Bones - myeloma cells can eat away at your bones and put you at high risk of fracture – often times in your hips, pelvis, or back (in your back, these are called compression fractures).

These are the so-called CRAB criteria and clinch the diagnosis of myeloma.

Velcade is a proteasome inhibitor, a drug that stops the cell’s trash can for proteins from functioning, whose cell killing may depend instead on shutting down another system that keeps the myeloma cell afloat, the NF-kB pathway.

Multiple myeloma cancer stages are vital in displaying intensity of tumors and the areas they have spread to. Each stage displays a unique pattern of formation and gives hints about probable risks involved in dealing with the disorder. It is necessary to understand stages of multiple myeloma cancer in order to initiate right treatment form and focus on early recovery of victim mentally and physically.

Detailed understanding about multiple myeloma cancer stages

Malignancy of plasma cells is a serious condition as it directly affects overall production of anti-bodies and also hampers functioning of protein-generating cells already present therein. This leads to weakening of bones and bone marrow and adversely impacts status of immune system of the victim. It also creates conditions suitable for malignancy to reach even the remote areas and pave way for other forms of cancers like lung, bone, blood, skin etc.

Also, the origin and development of cancer polyps can be of two main types – primary and secondary. Primary growth is a condition in which the malignancy originates in plasma cells and adjacent tissues and limits therein till at least the intermediate stages. Such growth can be easily controlled and further recurrence avoided if proper and timely action in the form of diagnosis and cure is taken. Suitable medical attention is mandatory while going through the process.

Secondary growth is more complicated and severe in comparison to primary one. It is a form of malignancy developing in different organs or regions of body simultaneously or in a phased manner and infects plasma cells in bone marrow at a later stage. Usually such cancer is detected quite late as symptoms displayed are quite similar with those detected during various other non-cancerous bone disorders. Hence, proper medical examination is the only option to interpret abnormalities correctly.

Stages of multiple myeloma cancer are the phases in which tumors develop and infect different regions of victim's body. Usually, the stages are classified into three unique forms with each form representing progressive behavior of polyps.

Main multiple myeloma cancer stages

Stage 1 is the basic condition representing level of hemoglobin to slightly above 10g/dL and calcium level less than 12mg/dL. Abnormal level of monoclonal immunoglobulin in urine or blood is another consequence detected. Damage to a bone or its portion can be seen.

Stage 2 is a condition showing moderate development of malignant cells in bone marrow. Mostly,t the malignant cells are located near the point of origin.

Stage 3 is a serious phase and needs to be addressed with proper medical expertise. Malignant cells develop in large numbers and may be scattered to different areas of body. Hemoglobin level falls severely to less than 8.5g/dL. Blood calcium level rises abnormally to more than 12mg/dL and monoclonal immunoglobulin is detected blood and urine in very high numbers. Destruction to bone is serious with more than 3 areas likely to get infected and damaged due to the malignancy.

Average multiple myeloma cancer survival rate is 29 months for the last phase. It is approximately 44 months for intermediate stages and 62 months for primary or first stage. The rate can be altered for better if proper treatment and post-treatment care is exercised by the victim.

Multiple myeloma cancer stages can be identified better if diagnosis methods used are apt and in accordance with condition of the victim. Considering medical history of victim and his family is very important during the process as it reflects on probability of multiple myeloma cancer recurrence.

Read more onhttp://www.thecorrect.com/questions-about-cancer.html

For patients that are candidate for autologous transplant, there are many treatments available and currently no one right way to go. Most patients would start with Velcade (bortezomib, usually now given SQ) and Dexamethasone (decadron) (IV or by mouth) given twice weekly for 2 weeks on and one week. Many myeloma physicians, as long as the patient is responding and feeling well, will attempt to augment this treatment by the addition of a 3rd drug, Revlimid (lenalidomide). Most physicians would treat patients for approximately 3 months and then move on to autologous transplant. After transplant, most physicians will give you "maintenance" therapy often starting 3 months after transplant using either Revlimid, Velcade, or both.

For patients that are not candidates for stem cell transplant, there are many treatments available and currently no one right way to go. I would suggest one of two treatments: 1) 3-drug therapy with Melphalan-Prednisone-Subcutaneous Velcade - we generally recommend the Velcade be given twice weekly for the first cycle and then weekly thereafter. We recommend about 9 cycles (42 days a piece) total, approximately 12 months and then maintenance on subcutaneous Velcadealone. For prevention we recommend acyclovir to decrease the risk of shingles. 2) Revlimid (lenalidomide) + Dexamethasone (Decadron) using weekly dexamethasone 40 mg once a week by mouth and Revlimid days 1-21 of a 28 day cycle. This we generally recommend continue for about a year and then move on to maintenance with Revlimid alone. For this regimen we recommend full dose enteric-coated daily to prevent againstvenous thromboembolism, a.k.a. a DVT.

Velcade is a treatment that is given by injection in the majority of myeloma cells and we believe it does increase the risk of varicella zoster (“shingles”) reactivation. To prevent against Shingles reactivation, we prescribe acyclovir 400 mg daily or twice daily depending on the patient’s kidney function as acyclovir is partly cleared by the kidney.

Currently, there are no approved adjuvant therapies for completely resected RCC and the standard of care remains observation. However, several agents have undergone testing in recent years in this setting and results have yet to be reported. Agents under study include the monoclonal antibody girentuximab (Rencarex) that targets the carbonic anhydrase IX protein on clear cell RCC tumors, and several antiangiogenic therapies including the TKI’s sunitinib, sorafenib, pazopanib, and the mTOR inhibitor afinitor. Adjuvant studies with pazopanib and afinitor are presently ongoing and available to patients with newly diagnosed high risk RCC.