1. Marisiensis 2015 University of Medicine and Pharmacy Tîrgu-Mure The treatment of multiple myeloma using Bortezomib (Velcade™) Author: Stanca Mihai Coauthors: Abaza Maria, Costache Roxana Coordinator: Asist. Univ. Dr. Cândea Marcela

2. A short Historical Overview of Multiple Myeloma Therapy Multiple Myeloma has been recognized since ancient times. The most commonly recognized case is that of Thomas Alexander McBean, a highly respectable tradesman from the 1850’s London. He was treated with steel and quinine and at that time, quinine was a relatively new agent and had been used for many different medical conditions.

3. In 1947 Nils Alwall from Sweden described two patients who were given a drug called urethane. The next major development was the recognition of melphalan or Alkeran, an alkylating agent discovered in 1958 by Professor Blokhin from Moscow. The latest discovery in the treatment of Multiple Myeloma is Bortezomib which was originally synthesized in 1995. In 2003 Bortezomib, marketed as Velcade, was approved by the FDA (Food and Drug Administration) for fighting against multiple myeloma.

4. This paraprotein has no useful function. The collections of the abnormal plasma cells acumulate in the bone marrow and interfere with the production of normal blood cells. Multiple myeloma or plasma cell myeloma is a cancer arising from plasma cells. These cells form a part of our immune system producing antibodies. In myeloma, these plasma cells become abnormal, multiply uncontrollably and release only one type of antibody – known as paraprotein.

5. The aim of this study is to analyze the prevalence of the responsiveness of patients with Myeloma using Bortezomib (Velcade™).

6. We conducted a retrospective study on a group of 63 patients with myeloma admitted in the Medical Clinic I – Hematologic Disease of Tîrgu-Mureş in 2014. We analyzed the prevalence of complete respondence, partial respondence and non-respondence in the treatment with Bortezomib(Velcade™) and also for some of the patients in our study which were not qualified for Bortezomib-based therapy.

7. For a better understanding of the results we made the following divisions: The average age was 69 years (rage 51-87) 52% were male.

8. The distribution by the area of the provenience showed that 67% came from rural places and 56% had a poor socio-economic status.

9. The division on the type of the monoclonal paraprotein secreted by the myeloma showed that: 82% had a predominance of IgG 16% IgA

10. According to Durie Salmon staging system: 89% of the patients were in stage II 8% were stage III, 3% were stage I.

11. 70% presented the symptom A meaning serum creatinine 2 mg/dL.

12. For the 59% of the patients treated with Bortezomib (Velcade™) these was administred in the recommended dose for adult patients:1.3 mg/m2 twice weekly for 2 weeks on days 1, 4, 8 and 11, followed by a 10-day rest period on days 12 to 21, of a 21- day treatment cycle. 57% of the patients got 8 treatments with Velcade™.

13. The following statistics represent the result of the treatment with Bortezomib (Velcade™)!

14. As a staging criteria for responsiveness we took in consideration the following main parameters from blood and bone marrow such as: The erythrocyte sedimentation rate (ESR) which is very high in Multiple Myeloma. For 65% of patients we found the ESR between 15-30 mm/h which is closely related with the good response of the treatment.

15. The proteic methabolism is affected in Myeloma In consequence the proteinograma will show a high level of proteins over 13g/dl with a decline of albumins and a growth of hipergamaglobulines. 49% of our patients presented a remission having the levels between 6-10 g/dl.

16. The level of plasmocytes in the bone marrow are also high in Myeloma. 51% of our patients presented <5% plasmocytes in the bone marrow which is closely linked with a good response of the treatment with Bortezomib (Velcade™).

17. The 59% of the patients treated with Bortezomib (Velcade™) obtained the following results:

18. The 17% of the patients corresponding to VAD obtained the following results: The results for the 24% patients treated with VMCP regimen are:

19. Bortezomib (Velcade™) produces a response in previously non-respondent patients with myeloma that results in an increased survival rate.

20. Thank you!