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Multiple Myeloma Patient Benefits From Drug

CancerWise - February 2008

By Scott Merville

Carl Hickman

When Carl Hickman learned he had multiple myeloma, the Tomball, Texas, dentist quickly hit the books to understand his cancer in-depth. “I found out I had about three years to live,” he says of the conventional wisdom at the time.

That was more than six years ago.

Today Hickman is catching his son’s high school football games and planning a family ski trip. Hickman and many other patients confronting this incurable cancer of the bone marrow are benefiting from new drugs that prolong survival and improve quality of life.

In Hickman’s case, the drug is lenalidomide, known commercially as Revlimid®, a derivative of the drug thalidomide, once banned for causing birth defects when taken by pregnant women.

“It’s just amazing,” Hickman says of the treatment during a lunch break from his dental practice. "I could function like this for a long, long while.”

Standard treatment may include stem cell transplant

Multiple myeloma is a cancer that develops in the bone marrow (the tissue in the center of bones that makes blood cells). It is caused when plasma cells (a type of white blood cell) rapidly overproduce, preventing the production of normal blood cells. This leads to the formation of a tumor called a myeloma. When there are a number of tumors present, the diagnosis is multiple myeloma.

Treatment for multiple myeloma begins with chemotherapy to reduce the number and size of bone marrow tumors and abnormal cells. Radiation is sometimes used directly against the tumors, mainly to relieve pain.

These treatments may or may not be followed by more potent chemotherapy that not only kills more bone marrow plasma cells, but also halts the production of normal blood cells from the bone marrow.

In anticipation of these treatments, the patient’s normal blood stem cells are collected, usually after a response to chemotherapy is noted. The cells are frozen so they can be transplanted back into the patient at a later date after high-dose chemotherapy is given. This autologous transplant restores normal blood production and usually results in a greater reduction of cancerous plasma cells.

Combined thalidomide treatment gives partial relief

After his diagnosis in October 2001, Hickman headed “straight to M. D. Anderson” where he came under the care of Raymond Alexanian, M.D., a clinical professor in the Department of Lymphoma and Myeloma.

Hickman’s initial treatment consisted of radiation and a combination of the steroid dexamethasone (Decadron®) and thalidomide (Thalomid®), then a new experimental treatment.

Thalidomide had been prescribed as a sedative in the 1950s and 1960s in Great Britain and was used to treat morning sickness until it was found to cause birth defects. Researchers continued to study the drug and found that it might be effective against multiple myeloma, attacking both the tumor and the new blood vessels that nourish it.

Before thalidomide, treatment for myeloma had remained relatively unchanged for decades.

Thalidomide treatment includes side effects

After six months of dexamethasone and thalidomide, Hickman’s disease was in partial remission, and he had an autologous bone marrow transplant. Such results relieve some patients for years, but Hickman’s brought only a short remission that held for a year.

He was soon back on dexamethasone and thalidomide and in partial remission. Hickman suffered common side effects of taking thalidomide: some confusion, a general weakness that he likens to feeling “deflated” physically, and peripheral neuropathy (pain, tingling and numbness in his hands and feet).

Prognosis is now better for more patients

During this time, the manufacturer of thalidomide, Celgene Corp., chemically tweaked the drug in hopes of reducing side effects and improving results. The new version was called lenalidomide.

Researchers studied the drug in a collaborative North American clinical trial that showed that lenalidomide, paired with dexamethasone, prolonged survival and reduced side effects for myeloma patients. Results were reported in the New England Journal of Medicine last November.

The trial results represent one of several big advances in the treatment of multiple myeloma, says the trial's lead investigator Donna Weber, M.D., an associate professor in M. D. Anderson’s Department of Lymphoma and Myeloma.

"Today in our clinic we have multiple myeloma patients who require treatment who have survived 10 years or more," she says. "When I started out in the early 1990s, you just didn’t see that very often.”

Entering the trial changes his life

Hickman entered the clinical trial, and it turned around his struggle with myeloma.

Initially, his disease progressed. Under the terms of the blinded clinical trial, his medication was revealed to be dexamethasone and a placebo, so he crossed over to taking lenalidomide. In addition to a nearly complete remission, Hickman’s side effects improved dramatically.

He has periodic leg weakness and general malaise, but they are associated with taking dexamethasone, not the lenalidomide. The timing of the side effects is easily predicted, so Hickman simply plans a lighter work load at his practice on those days.

As for the neuropathy, “my hands went back to normal, and all that’s left is a little tingling in my feet.”

Today his life is full, and his prognosis remains good.

“I’m enjoying my family, I’m a full-time dentist, and I’m participating in outdoor sports that I love,” Hickman summarizes. “All in all, it’s been a very good experience.”

M. D. Anderson resources:

© 2015 The University of Texas MD Anderson Cancer Center