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Spring 2000 Volume 3, Issue 8:
Did You Know?
By Brian G.M. Durie, MD
New treatment for spinal compression fractures; STI-571: "A miracle pill for the treatment of Chronic Myelogenous Leukemia"
04.01.00
These days it seems there is always something in the news which sounds like it might be helpful for myeloma patients. Often new technologies just don’t apply to myeloma since it is such a specialized disease. But sometimes there can be direct applications and/or possibilities for new approaches.

New Treatment for Spinal Compression Fractures

Painful compression fractures of the spine are common in myeloma patients. A procedure known as percutaneous vertebroplasty has been available as treatment for some time. This procedure involves injection of liquid cement into a damaged vertebra in an effort to recoup the height and shape of the collapsed vertebra. Unfortunately, for myeloma patients this has been only partly successful because the shattered vertebrae do not retain the liquid cement within the vertebral space. The cement can leak out into the surrounding tissues with thus only partial benefit. An orthopaedic surgeon at Johns Hopkins University Medical Center, Dr. David Cohen, has introduced a new technique which overcomes this “leakage” problem. The new procedure, called “Balloon Kyphoplasty” (note: “kypho” means curvature, “plasty” means correction), relieves both the pain and complications of spinal deformity. Dr. Cohen inflates a balloon, under X-ray guidance, right into the space left by the collapsed vertebra. Using the balloon as a cast, the liquid cement is injectedinto the exact area in which the height of the vertebra needs to be restored. The balloon is subsequently removed, leaving solid cement support in the correct spot. Initial studies showed excellent pain relief and 70% recovery of lost vertebral height plus 50% reduction in stooping. Obviously, this is a technique to be considered in selected patients and situations. However, initial results seem quite promising.

STI 571: A “Miracle Pill” in the Treatment of Chronic Myelogenous Leukemia

At the December 1999 meeting of the American Society of hematology, perhaps the most exciting report was the amazing (100% response) benefit reported with a new enzyme inhibitor specifically targeted against an abnormal protein (Bcr-Abl fusion protein) produced by chronic myelogenous leukemia cells. The enzyme inhibitor STI 571, developed and tested by Dr. Brian Druker from Oregon Health Sciences University in Portland, selectively blocks the abnormal Bcr-Ablprotein which is novel cancer associated protein which strongly activates a critical cell growth membrane system called tyrosine kinase.

The $64,000 question was posed to Dr. Druker by Dr. Timothy Johnson of ABC News on a February 14, 2000 webcast:

Question: Will this new leukemia pill also work for multiple myeloma patients?

Dr. Drucker: STI-571 was developed to treat CML (Chronic Myelogenous Leukemia). Each cancer or leukemia is driven by different abnormalities and STI-571 was developed to shut down the specific abnormality that drives CML. However, there is much research being done to determine what drives the growth of myeloma cells, so that a drug like STI can be made for myeloma. Given our success with CML, I believe there is much hope for the future of cancer treatment.

Question: How do you get more information?

Dr. Drucker: There are several ways. Patients can call Novartis Oncology at (800) 340-6843. They can also look at the Novartis website www.novartisoncology.com. Our phone number is (503) 497-1117, and our website is www.ohsu.edu\occ-leukemia.

Clearly, there is the possibility of testing in myeloma. However, a new drug specifically targeted against abnormal protein production in myeloma is what is going to be required. The success in CML gives great hope for the future of this type of strategy. Stay tuned!


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