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Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence

Alan Bryce, MD Staff Oncologist, Mayo Clinic Arizona. Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence. Scottsdale, Arizona. Rochester, Minnesota. Jacksonville, Florida. Multiple Myeloma - Background. The Bone Marrow (blood factory) makes 3 kinds of cells:

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Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence

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  1. Alan Bryce, MD Staff Oncologist, Mayo Clinic Arizona Introduction to Myeloma:Diagnosis, Treatment, Risk Factorsand Prevalence Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida

  2. Multiple Myeloma - Background • The Bone Marrow (blood factory) makes 3 kinds of cells: • White Blood Cells …immune system • Red Blood Cells (Hemoglobin) …carry oxygen • 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

  3. 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…

  4. Asymp- tomatic Myeloma Spectrum of Myeloma Aggressive Myeloma Normal plasma cell MGUS Active Myeloma Monoclonal gammopathy of unknown significance

  5. How do plasma cells become “evil”?

  6. 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…

  7. 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 Transplant 3. Novel Drugs (thalidomide, bortezomib, lenalidomide)

  8. 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

  9. Myeloma rate in Arizona among race groups, 1995-2009

  10. 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

  11. 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

  12. 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

  13. Diagnosis of Myeloma The diagnosis of Myeloma is made as a result of several tests: • Blood Counts (CBC – white, red, platelets) • Blood and urine tests for immune proteins 3. Bone Marrow tests (aspirate and biopsy) 4. X-rays 5. Other blood tests

  14. 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

  15. 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

  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

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