In Poland, as the only EU country, optimal therapy is not reimbursed for people waiting for a bone marrow transplant due to a cancer of the hematopoietic system of multiple myeloma – doctors are alarming
Access to it would double the lives of patients, they estimate.
Poland is the only country in the European Union that has an old first-line treatment regimen for patients with myeloma qualified for autologous bone marrow transplantation, says Dr. Dominik Dytfeld from the Medical University of Karol Marcinkowski in Poznań.
The hematologist explains that autologous bone marrow transplantation involves transplanting the patient’s own hematopoietic stem cells. For this they must first be taken and frozen. Then, the patient’s bone marrow must be destroyed with very strong chemotherapy (sometimes referred to as mega-chemotherapy) and the stem cells must be transplanted back to regenerate the bone marrow.
This procedure significantly extends the life of patients with myeloma, although it does not cure, the cancer always recurs after some time, explains Dr. Dytfeld.
Because it is a heavy burden on the body, doctors offer it to younger patients with myeloma – usually up to 65 or 70 years of age and in good general condition, without coexisting serious diseases, such as ischemic heart disease or chronic obstructive pulmonary disease. According to the chairman of the Polish Szpiczakowa Group, prof. Anna Dmoszyńska, they constitute less than 50 percent. all patients with this cancer.
Dr. Dytfeld reminds that although myeloma is still an incurable cancer, the survival of people suffering from it has increased at least twice in the last 15 years, thanks to the introduction of new drugs from two groups: immunomodulating drugs (thalidomide, lenalidomide) and the so-called proteasome inhibitors. “When I started working 12 years ago, the patient lived an average of three years, and now six or seven years. But some patients live 10 years or more. We owe this change to new drugs “- emphasizes the specialist. However, he points out that there are very large differences between patients, depending on their risk factors.
What we have been fighting unsuccessfully for several years is the possibility of using bortezomib in the so-called induction treatment in patients qualified for autotransplantation of bone marrow hematopoietic cells – explains prof. Dmoszyńska.
The drug inhibits the action of the proteasome, an enzyme complex that acts as a document shredder in cells by destroying and degrading proteins that are no longer needed. The Nobel Prize in Chemistry was awarded in 2004 for the discovery of this mechanism of organizing the inside of cells.
In myeloma cells, the activity of the proteasome is very high, bortezomib inhibits it, and then the cells become messy and their important signaling pathways are disturbed, says Dr. Dytfeld. This causes the tumor cells to eventually die by suicide in the process of the so-called apoptosis.
The use of bortezomib as one of the three drugs before autotransplantation doubles the survival of patients, emphasize hematologists.
Throughout the European Union, including Bulgaria and Romania, it can be administered together under the so-called Induction therapy together with the steroid drug dexamethasone and thalidomide, or the cytostatic drug adriamycin, noted Dr. Dytfeld. In Poland, however, we still use the old regimen – instead of bortezomib, we give the older cytostatic drug cyclophosphamide – he explains.
Hematologists admit that the drug is expensive. Usually, it is enough to give 3-4 cycles (which lasts about 3 months), and the cost of such therapy is about PLN 65.
However, experts from the Polish Myeloma Group calculated that the use of triple therapy with bortezomib in a group qualified for autotransplantation would cost PLN 22-25 million annually. “This amount is acceptable in our opinion. There are much more expensive therapies “- assessed prof. Dmoszyńska.
When asked by PAP about whether the Ministry of Health is working on financing induction therapy with bortezomib for myeloma patients awaiting autotransplantation, the spokesman for the ministry, Krzysztof Bąk, informed that proceedings in this area are currently underway. The minister of health is analyzing the offer of the drug manufacturer who submitted the application in this matter – he stressed.
He also reminded that currently, as part of the drug program, treatment with bortezomib is funded for patients with newly diagnosed myeloma who do not qualify for bone marrow autotransplantation and meet at least one of the three criteria: they have kidney failure, a specific cytogenetic disorder, and are 75 years of age or older.
In addition, bortezomib is funded for myeloma patients who develop resistance to therapy or relapse after successful therapy.
In Poland, bortezomib in the first-line treatment can only be used to a very limited extent in elderly patients – says Dr. Dytfeld.
As he points out, multiple myeloma is still an incurable disease, but thanks to new therapies, which appear more and more, it will be possible to make it a chronic disease with which one can live a good quality life. In some patients it is already possible to achieve this.
Multiple myeloma is a cancer of the haematopoietic system which originates in mature B lymphocytes (so-called plasma cells). Every year, 1300-1500 new cases of myeloma are diagnosed in Poland, and more than 10 people live with this cancer in our country. people. Mostly it is found in people over the age of 65. (PAP)