49ers Linebackers Coach Johnny Holland, 56, Has Multiple Myeloma Relapse; Understanding This Rare Blood Cancer

"In sharing the details of my diagnosis, my desire is that I can be an advocate and beacon of hope for those who are battling cancer to help remind them that we're all in this together," Holland said.

Holland, 56, was first diagnosed with multiple myeloma in September 2019, and unfortunately, nearly two years later, it has returned. He will begin another round of treatment at the Stanford Medical Center and the University of California-San Francisco Medical Center.

But what is multiple myeloma? And why does it affect Black Americans like Holland twice as much as other races? SurvivorNet is here to answer all your questions about this rare and complicated blood cancer.

Understanding Multiple Myeloma

Multiple myeloma is a rare type of blood cancer. Dr. Jens Hillengass, chief of myeloma at Roswell Park Comprehensive Cancer Center in Buffalo, goes a step further, telling SurvivorNet that multiple myeloma is "very, very rare."

"It's only in a very, very low number of people in the whole country, in the whole world," he says. "It depends on certain factors, but mostly, actually, on race."

When you have this type of cancer, white blood cells called plasma cells the cells that make antibodies to fight infections in your bone marrow grow out of proportion to healthy cells in your body. With the growing number of abnormal cells, there is less room for the healthy blood cells your body needs to fight off infections.

Risk factors associated with multiple myeloma are namely race and ethnicity. Black Americans have the highest risk for developing this type of blood cancer.

There are certain factors that increase your likelihood of developing this cancer. (People are often diagnosed with multiple myeloma after seeing their doctor for persistent tiredness or other unusual symptoms.) But it's important to remember that just because you may have one or any of the factors listed below doesn't mean you have, or will develop, this rare cancer. (It's also possible to have no risk factors and still develop multiple myeloma.)

• Age Most people with multiple myeloma are diagnosed in their 60s, but it's possible to get this cancer earlier in life, like Holland, who is 56.
• Family history Having a parent, sibling or other close family member with multiple myeloma can increase your risk of developing this cancer.
• Gender Men are at a slightly higher risk than women for getting this cancer.
• Race Black Americans are twice as likely to get this cancer than other ethnicities, although blood cancers are typically less common among Black patients. (T-cell lymphomas another type of blood cancer also tend to be more common among Black patients.)

When it comes to both getting cancer and surviving it, serious racial disparities exist in the United States.

"We're not exactly sure why these cancers may be more common among African Americans," Dr. Adrienne Phillips, a medical oncologist at Weill Cornell Medicine, previously told SurvivorNet. "It's probably multifactorial and a combination of genetic risks and environmental exposures. … Research is ongoing to identify environmental exposures and perhaps genes that could confer a higher susceptibility (to multiple myeloma.)"

Multiple Myeloma Relapse Treatment Options

This will be Holland's second time battling the rare blood cancer in about two years. Dr. Vincent Rajkumar, a medical oncologist at the Mayo Clinic in Rochester, Minn., tells SurvivorNet that the first relapse of multiple myeloma occurs at a median of four years.

If you are also dealing with relapsed multiple myeloma, there are various treatment options available to you.

"We can treat myeloma very well even if the disease comes back, and even if it comes back again, and even if it comes back again," Hillengass tells SurvivorNet.

But what is the best standard of care for the first relapse of multiple myeloma? Hillengass calls that the "$1 million dollar question."

"There's a lot of discussion amongst experts (about) what is the standard of care for relapsed myeloma, and there is not really a standard of care," he says. "What we know now from a lot of research studies (is) that the three-drug combination seems to be, at the moment, the best treatment, and which three drugs your doctor uses depends very much on your side effect profile from the first treatment, on other diseases you might have, (and) on how long you had until your disease came back."

Hillengass explains that there are various treatment options he would use when treating relapsed myeloma. One type of therapy that has been very effective, he says, is called antibody therapy, which includes monoclonal antibodies, antibody-drug conjugates and bispecific antibodies.

“They are made to find a protein on the surface of the plasma cells to basically attack those cells directly and also engage the immune system, the healthy part of your immune system, to attack the plasma cells, the malignant (cancerous) cells,” he tells SurvivorNet.

Those antibody drugs are usually paired with immunomodulatory drugs, which also engage the immune system to attack the cells, and they also attack the cells directly. This combination of antibodies and immunomodulatory drugs is “very effective,” according to Hillengass.

Oncologists differ on exactly the right treatment for relapsed myeloma, but with so many treatments available, patients have many options for response.

There is a third treatment option for the first relapse of multiple myeloma, which are so called proteasome inhibitors, which destroy cancer cells by suffocating them.

“There are other options,” he says, “but these are most common in (the) first relapse of the disease.”

Rajkumar tells SurvivorNet that most oncologists who treat multiple myeloma “would prefer” a monoclonal antibody-based combination of drugs for the first relapse of the disease.

"We have a lot of options to choose from (for treatment), and nowadays we can really individualize the treatment and give the patient something that fits very well in her or his situation," Hillengass tells SurvivorNet.

There are a number of different options for the patient with relapsed myeloma, including a number of different drug combinations.

Learn more about SurvivorNet's rigorous medical review process.