The summary below is from the full report titled "Plasma Exchange When Myeloma Presents as Acute Renal Failure. A Randomized, Controlled Trial." It is in the 6 December 2005 issue of Annals of Internal Medicine (volume 143, pages 777-784). The authors are W.F. Clark, A.K. Stewart, G.A. Rock, M. Sternbach, D.M. Sutton, B.J. Barrett, A.P. Heidenheim, A.X. Garg, D.N. Churchill, and the Canadian Apheresis Group.

What is the problem and what is known about it so far?
 

Multiple myeloma is a type of cancer that causes overgrowth of abnormal (malignant) cells in the bone marrow. These malignant cells release a large amount of abnormal protein (myeloma protein) into the bloodstream. Myeloma protein can be removed by the kidney and can be excreted in the urine. Unfortunately, the kidney often becomes blocked by large amounts of myeloma protein, and kidney function often deteriorates by the time that multiple myeloma is first diagnosed. Doctors have tried to prevent further deterioration of kidney function by performing a procedure called plasma exchange. Plasma exchange is done by removing blood from a vein and then separating the liquid portion of the blood (the plasma) from the red blood cells. The patient's plasma (which contains myeloma protein) is then discarded and is replaced with plasma from healthy donors before returning it to the patient's bloodstream. Plasma exchange is now recommended by 2 large medical organizations.

Reprinted from the NCI Cancer Bulletin, vol. 3/no. 11, March 14, 2006

Current treatment for multiple myeloma entails a long and intricate chemotherapy regimen that includes one or two transplants with a patient's own stem cells accompanied by the drug melphalan. The anti-angiogenesis agent thalidomide has proven to be an effective component of therapy, but questions remain about where in the course of treatment it can best be used. In the March 9, 2006, issue of the New England Journal of Medicine (see the journal abstract), researchers report superior event-free and complete response rates when the drug was used before and during primary therapy and also thereafter for maintenance. Yet the controls who took no thalidomide lived just as long.

Summary

In this randomized trial, multiple myeloma patients treated with high-dose chemotherapy and radiation therapy (HDT) followed by stem-cell transplantation fared no better than those treated with standard chemotherapy in terms of progression-free survival or overall survival. These findings conflict with earlier trials; further studies are required to clarify the issue.
Source

Journal of Clinical Oncology, published online Jan. 23, 2006; in print February 20, 2006 (see the journal abstract).
(J Clin Oncol. 2006 Jan 23; [Epub ahead of print])

In this phase III clinical trial, older patients – most over the age of 65 – with previously untreated multiple myeloma did significantly better than a comparison group when thalidomide was added to the conventional chemotherapy melphalan plus prednisone (MP). These results provide the first solid evidence of thalidomide’s effectiveness in this group of elderly patients.

Source: The Lancet, March 11, 2006 (see the journal abstract)
(Lancet. 2006 Mar 11;367(9513):825-31)