Flowing through your body, you have a well-orchestrated balance of cells in your blood that keep your body functioning at its best. Responding to your body’s every move, your blood cells quickly adjust to provide adequate oxygen and nutrients to each of your body’s cells, carry waste products away, and help you to ward off or heal illness and injury.
In health, this perfect equilibrium between the body’s needs and the production of specific blood cells keeps you healthy and well. But sometimes, and often for reasons unknown, there is a disruption to normal blood cell production. This is the case with a particular blood cancer that we’re going to discuss, called multiple myeloma.
Rushang Patel, MD, PhD hematologist and medical oncologist at Florida Hospital Medical Group’s Blood & Marrow Transplant Center, explains what multiple myeloma is as well as exciting treatments that are providing hope to those affected by this disease.
Multiple Myeloma Basics
Bone marrow is found in the hollow of one’s long bones. The stem cells that give birth to other types of blood cells live in the bone marrow. There are three main types of blood cells - white blood cells, red blood cells and platelets. While each person has the same red cells and platelets, there are many different types of white blood cells, one of which is called the plasma cell.
Dr. Patel says, “It’s important to understand what plasma cells do — each plasma cell makes a special protein called an antibody that targets a specific foreign object (like bacteria, viruses or fungus) to protect our bodies.”
“Multiple myeloma is a cancer formed by malignant plasma cells,” explains Dr. Patel. “It is the third most common blood cancer in the U.S. and makes up about 1.4 percent of new cancer diagnoses.”
“When a group (or clone) of plasma cells become cancerous, they erratically divide and multiply, creating extra proteins in the blood that affect the balance of the other blood cells’ production,” explains Dr. Patel.
He adds that with multiple myeloma, hemoglobin can go down, blood calcium levels can rise to dangerous levels, bone fractures may occur and kidney function can decline.
Symptoms of Multiple Myeloma
Dr. Patel describes that there are three distinct phases of multiple myeloma, which define how the disease progresses and the symptoms that present. “It’s important to know that having a few cancerous plasma cells doesn’t mean patient has myeloma or needs treatment. In fact, some patients in the first phase of multiple myeloma can go years with monitoring and no treatment”
Multiple myeloma can be diagnosed in several different ways. In earlier stages, a patient’s routine lab work as part of their annual physical could pick up on some blood cell protein abnormalities. In more advanced phases of the disease, bone pain, excessive tiredness or kidney problems could be the first indicators.
“While multiple myeloma tends to be a disease the mainly affects the elderly and does have some ethnic variations, this disease does not have an identified cause or specific risk factors,” notes Patel.
Treatment for Multiple Myeloma
“Even though multiple myeloma is not curable, it is controllable and many new treatments have been developed or are on the horizon,” remarks Dr. Patel.
As a result of improved treatments, survival of patients with multiple myeloma is most often measured in years, not months. Dr. Patel adds, “Many people can survive (and live a good quality of life) with multiple myeloma for ten years or more.”
Dr. Patel suggests, “Think of multiple myeloma as an iceberg. If it stays under the surface of water, it doesn’t harm the body. If it rises above the water’s surface, it can become harmful to the body and needs treatment.”
Treatment often starts with four to six cycles of induction chemotherapy, which is usually about three different medications. “Chemotherapy can help chop the iceberg down under the water’s surface, but it can’t keep it there, so induction chemotherapy should be followed by with an autologous stem cell transplant,” explains Dr. Patel.
An autologous stem cell transplant is part of the current standard of care for multiple myeloma. Dr. Patel states, “The good thing about an autologous transplant is that we use the patient’s own cells so there is no chance of rejection and there is less than a one percent mortality rate related to the transplant itself.”
And even better, most patients see positive outcomes with little complications after the transplant, which requires a hospital stay of two weeks or less.
“This transplant chops the iceberg all the way to bottom; while we can’t get rid of it entirely, it takes longer to grow back and come above water,” says Dr. Patel.
Beyond the transplant, maintenance chemotherapy might be needed, which uses medicine at half or a third of traditional chemotherapy doses. This is often provided in the form of a pill that patients can take at home with the goal to slow the growth of myeloma in the body after the transplant.
Sometimes, a second transplant can be a treatment option if a relapse occurs 18 to 24 months after the first one.
New Hope for Multiple Myeloma at Florida Hospital
“We have experienced an exponential growth in multiple myeloma treatments in the last two to three years,” says Dr. Patel.
“There are two antibody-based treatments that specifically try to target the proteins on the plasma cells in order to control the myeloma. Another promising treatment in early clinical trials is CAR T cell treatment, which uses the patient’s own immune power to control cancerous plasma cell growth.”
Dr. Patel explains that Florida Hospital is in the process of starting its own CAR T cell trials, in addition to many additional multiple myeloma research trials. “We’re on the forefront of new treatments that use the patient’s own immune system to treat cancer, including using immune modulated agents that can target cancerous plasma cells and essentially shut down their production and eliminate them.”
“Our treatments have moved away from high toxicity chemotherapy and toward well-designed, purposeful medicines that do specific jobs with fewer side effects,” notes Dr. Patel.
Dr. Patel’s Message to You
“A bone marrow transplant provides one of the most personalized medicines available today — it pushes the boundaries of what medicine can do to treat and cure cancer, and it’s been a passion of mine since I did my oncology training,” shares Dr. Patel.
It is this spirit to always provide hope and innovation that drives Dr. Patel’s work today at Florida Hospital Medical Group’s Blood & Marrow Transplant Center, which performs over 120 stem cell transplants a year and has been recognized nationally as one of only 17 programs of 178 across the U.S. with better than expected outcomes for its patients.
Treating all types of blood cancers, the center performs some of the most revolutionary and successful bone marrow/stem cell transplants, including half-match transplants. Dr. Patel explains that with only traditional stem cell transplants, only about 30 to 40 of patients found a donor, but now, with the half match transplant, 90 to 95 percent of patients can find a donor and be eligible for a transplant.
“Florida Hospital is a place full of hope — we strive to be the best as a medical team and provide the best possible care to help our patients heal every step of the way,” concludes Dr. Patel.