Introduction to Myeloma:Diagnosis, Treatment, Risk Factors

and Prevalence

Scottsdale, ArizonaScottsdale, Arizona Rochester, MinnesotaRochester, Minnesota Jacksonville, FloridaJacksonville, Florida

Alan Bryce, MDStaff Oncologist, Mayo Clinic Arizona

Multiple Myeloma - Background

• The Bone Marrow (blood factory) makes 3 kinds of cells:1. White Blood Cells …immune system 2. Red Blood Cells (Hemoglobin) …carry oxygen3. Platelets …clotting

• There are several kinds of white cells in the marrow

• usually 1-3% of them are PLASMA CELLS

• plasma cells make good proteins – antibodies or “immunoglobulins” which help fight infection

Multiple Myeloma - Introduction

• Myeloma is a cancer of the Plasma Cells• They grow out of control in the bone marrow (at least

10% and as high as nearly 100%)• This results in many problems including:

• Low hemoglobin (anemia) and platelets• Elevated abnormal immunoglobulins (proteins)• Bone pain and fractures• Infections (partly due to low normal

immunoglobulins)• Kidney problems• Other complications…

Spectrum of Myeloma

Normal plasma

cell

Asymp-tomatic

Myeloma

Aggressive Myeloma

Active Myeloma

Monoclonal gammopathy of unknownsignificance

MGUS

How do plasma cells become “evil”?

Multiple Myeloma – Causes?

• The cause of myeloma is still unknown

• Some have suggested:• Radiation- Nuclear Bomb Survivors• Chemicals (benzenes), herbicides and

insecticides- The “Myeloma Belt”• Genetics or even viruses

• Familial Myeloma – still rare

• However, nothing is conclusive, and it is likely a combination of many factors…

Multiple Myeloma

• Unfortunately, MM is not a curable disease (yet!!)

• Historically most people did not live for much more than 2 years…

• However, the average survival is now at least 8 years• This has been a result of three key

developments:1. Early Detection 2. Autologous Stem Cell Transplant3. Novel Drugs (thalidomide, bortezomib,

lenalidomide)

Multiple Myeloma - Epidemiology

• Incidence• It is a rare condition, occurring in about 4 people per

100,000 (1% of all cancers)• About 2100 new cases this year in Canada

• It is more common in men than women

• It is more common in the black population

• Average age of diagnosis is 65• Less than 10% of cases occur in patients <50• Less than 2% of cases occur in patients <40

©2012 MFMER | slide-9

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Myeloma rate in Arizona among race groups, 1995-2009

Common Symptoms

• Not all patients will have all of these symptoms

• Fatigue• Mostly due to low hemoglobin (anemia)• Also due to disease itself• Other factors contribute to this (psychological, chemo &

other drugs, infections…)

• Lack of Appetite

• Infections• Due to weakened immune system

Common Symptoms contd.

• Bone Symptoms• The abnormal protein causes an imbalance in bone

production leading to bone thinning• This bone loss can lead to osteoporosis, bone pain and

bone fractures• Most common location is the spine

• High Calcium levels• Often happens when first diagnosed (calcium released by

damaged bones)• Can result in thirst, nausea, vomiting, frequent urination,

confusion and even coma

Common Symptoms contd.

• Impaired Kidney Function• The abnormal protein and the high calcium can

damage the kidneys• About ½ of patients have some degree of kidney

damage• Some have severe damage and require dialysis

• Neurological symptoms• Bone fractures may compress nerves and cause

symptoms

• Easy bruising & bleeding occurs in some

Diagnosis of Myeloma

The diagnosis of Myeloma is made as a result of several tests:1. Blood Counts (CBC – white, red, platelets)2. Blood and urine tests for immune proteins3. Bone Marrow tests (aspirate and biopsy)4. X-rays

5. Other blood tests

Myeloma Treatment

• Principles of therapy

• 1. Stop the production of the abnormal plasma cells (chemo)

• 2. Strengthen the bone and prevent fractures

• 3. Increase the hemoglobin count and reduce fatigue

• 4. Reduce risk of infections

• 5. Promote well being and quality of life

Treatment with Chemotherapy

• Goal is to reduce the number of plasma cells and the proteins they produce

• Timing is important as it may be possible to wait & watch

• It is not “curative” but may put the disease into remission

• Must be tailored to individual based on disease factors (type, severity, organs involved) and patient factors (age, general health…)

• Stem Cell Transplant is a common treatment option

©2012 MFMER | slide-16

Conclusions

• New Treatments for myeloma have improved survival

• Myeloma is usually preceded by many years of MGUS

• Screening and early detection can allow therapy to begin before organ damage develops

• Bone Marrow transplant and Clinical Trials should be considered when appropriate