Multiple Myeloma – An Introduction

Multiple Myeloma – An Introduction


[music] Myeloma is a blood cancer. It arises from a cell called a plasma cell,
which is an important part of one’s normal immune system producing antibody. The importance of symptoms of diagnosis are
critical obviously for diagnosis and probably initiating treatment to reverse the symptoms. But what typically happens is patients are
identified with a high serum protein or some other end organ function of their disease. for example that they can have a low hemoglobin,
or they’ll be slightly anemic, and that can then trigger an investigation that finds
the disease. And it starts as what’s called a Monoclonal
Gammopathy of Uncertain Significance, then becomes a smoldering process and then becomes
an active disease. Unfortunately when it’s in active form it
can be very dangerous, it requires prompt therapy, and until recently unfortunately
it used to have a poor prognosis, but fortunately over the last 10-15 years the outlook has
been transformed favorably by the advent of what we call novel therapies. It’s a time for great hope in myeloma. You know, when you’re diagnosed with an
incurable cancer, you sometimes use the word, incurable, with terminal, and you hear the
word, terminal, you think you’re going to die tomorrow, and that’s how I felt when
I was newly diagnosed. But as I got over the shock of that initial
diagnosis I realized that many people are living very long lives with multiple myeloma. I have some friends who were diagnosed over
20 years ago, and seeing these patients, you know, seeing these people still alive and
active, and enjoying life, I know that being, even being diagnosed with an incurable, terminal,
cancer, doesn’t mean your life stops, you can still live your life, and I’m still
living mine. Multiple myeloma is the correct description
because it’s it multiple sites of these aggregate plasma cells within the bone and
bone marrow. So, hence the term multiple myeloma. Myeloma arises actually in the lymph nodes
but moves into the bone marrow. And when it moves into the bone marrow it
grows and proliferates. It crowds out normal hematopoiesis, so normal
blood cells are suppressed including red blood cells, white cells, and platelets, and it
also attacks bone, what we call lytic bone lesions. The protein that it produces can not only
thicken the blood but it can also damage the kidney and it can produce other symptoms. And finally, and most important, myeloma is
highly immunosuppressive, so in that context it can produce a profound immunosuppression
making the patient vulnerable to infections and also compromising their ability to fight
any kind of major infectious or other issue. As a result of the effects it has on bone,
it can also produce high levels of a chemical called calcium, and one of the presenting
features in addition to renal failure can be what’s called hypercalcemia. When you’re diagnosed with myeloma, it’s
important to know if you’re experiencing any of the CRAB symptoms. CRAB is an acronym that myeloma specialists
use, and C means if you have any high calcium levels, the R means if your renal function
is working or not, the A is for anemia, the B is for bone pain and bone disease, and some
myeloma specialists include an I for reoccurring infections. And if you’re experiencing any of those
symptoms when you’re diagnosed, you will begin myeloma treatment almost immediately. Some of the things someone newly diagnosed
with multiple myeloma should know, is first to relax, keep calm, and get a game plan together. Although being diagnosed with an incurable
cancer can be devastating, there are many treatment options for someone newly diagnosed. Having myeloma is kind of like running a marathon,
not a sprint. You need to educate yourself, so that you
can ask questions and make informed decisions. And you need to gather together a network
of support, people who will be there to help and guide you every step along the way. The first thing that a patient should think
about is that there are numerous treatment options available. We now realize that one size does not fit
all. So it’s important for patients to access
top centers, top sites, and have the best expert opinions in guiding their therapy because
it’s becoming increasing sophisticated and nuanced, how to best manage their disease. And to decide which treatment is best for
you, you need to have a discussion with your doctor. You need to know what kind of myeloma you
have. You need to know if it’s a high-risk type
of myeloma, standard risk, or an intermediate risk. You need to know if you have any chromosomal
abnormalities, and you need to know some quality of life issues, that you’re willing to trade
off. Someone with diagnosed as multiple myeloma
has a lot of treatment options available to them. First, they could consider drug therapy, stem
cell transplantation, or clinical trials. You want to know the risk and benefits of
each of those treatment options. You might ask your doctor what treatment plan
they would suggest that you start with, and why they suggest that treatment plan for you. There is a lot of exciting research happening
in the area of multiple myeloma. Since I was diagnosed in 2008, there has been
seven new drugs approved, that’s kind of amazing. And there are many, many drugs in the pipeline
for myeloma. I think clinical trials in myeloma are tremendously
important, because we’re trying to continuously advance the field and some of the most exciting
developments in the field include the use of immunotherapeutic strategies early and
that can only be accessed in the context of a clinical study. Furthermore we’re also looking at strategies
to best place transplant, does transplant now belong initially in all patients or should
it be kept in reserve, and studies are actively addressing that at the moment. Everyone should be considering a clinical
trial as one of their treatment options, whether you are newly diagnosed or relapsed refractory. There are multiple resources for patients
with myeloma. Cancer.Net is one excellent source to go to,
I should mention there’s also the IMF and the MMRF both of who provide fabulous patient
advocacy and information, in particular around research opportunities. [music]