Multiple Myeloma: Overview

What’s also incredible encouraging is that there continues to be new treatment options, and therapies considered novel a few years ago are very quickly gaining traction. These can include immunotherapies such as CAR-T cells and a growing number of drug combinations. The myeloma specialists call them triplets, and there are even quadruplets composed of four drugs.

There are also a huge number of clinical trials being conducted for multiple myeloma. SurvivorNet has extensive resources about how to access these options as well.  At every stage of cancer, it is critically important to be your own advocate. For relapsed multiple myeloma it can be very challenging to discover the option that is right for you. Academic centers and large comprehensive cancer centers are places that most often have access to the latest treatments and research and its often possible to get a second opinion at one of these centers.

Scialfa, 71, revealed she was diagnosed with early stage multiple myeloma in the new Springsteen documentary titled “Road Diary: Bruce Springsteen and The E Street Band.”

Fans learned of Scialfa’s health battle in the documentary, which made its premiere at the Toronto International Film Festival (TIFF) over the weekend. The film is set for release on Hulu and Disney+ on October 25.

“Twenty Grammy Awards, record-setting concerts, albums charting in the Top 5 in each of the last six decades — as a musician, Bruce Springsteen has conquered just about every mountain there is to climb. From that high vantage point, an artist gains a unique perspective,” TIFF describes the documentary.

“That’s what Springsteen brings to Road Diary: an evocative look back at the path he and his band have blazed since the ’70s, and a look forward to what lies on the horizon. Mortality, yes, but also more of the passion, energy, and grit they’ve always brought to touring, as they prepare to hit the road one more time.”

Scialfa, who has been married to Springsteen since 1991 and the “E Street Band” years prior, in 1984, didn’t attend the documentary premier on Sunday night, however, she is reportedly seen in the film addressing her health struggle.

“I’ve been performing with this band for 40 years. With those first performances, it felt so good to be back onstage,” she said in the documentary, according to People.

“Touring has become a challenge for me. In 2018, well, Bruce and I were doing a play on Broadway. I was diagnosed with early stage multiple myeloma.”

RELATED: Legendary Anchorman Tom Brokaw, 84, On Emergency Hospitalization During Cancer Treatment– His Remarkable Journey Living For Years With Blood Cancer

She explained further, “This affects my immune system, so I have to be careful what I choose to do and where I choose to go,”

“Every once in a while, I come to a show or two and I can sing a few songs on stage, and that’s been a treat. That’s the new normal for me right now, and I’m OK with that.”

@hulu

Road Diary: Bruce Springsteen and The E Street Band follows Springsteen and the band through their one-of-a-kind preparation process. Coming to Hulu and Disney+ on October 25. #SpringsteenRoadDiary

♬ original sound – hulu

Scialfa also expressed her love for touring and singing “Fire.” with her beloved husband.

“You can see a side of our relationship that you usually don’t get to see. Being back onstage with Bruce is a blast. Every night at this tour gives the band a chance to celebrate,” she added.

Meanwhile, Springsteen has also been coping with some health issues of his own, as he took a break from performing last year due to peptic ulcer disease, a digestive disorder that may increase one’s stomach cancer risk.

RELATED: Do Bruce Springsteen’s Stomach Ulcers Increase the Risk For Cancer?

Despite it all, Springsteen, 74, reportedly says on the documentary that he’ll continue performing until “the wheels come off,” noting, “If I went tomorrow, it’s Ok. What a f***ing ride!”

In celebration of the upcoming documentary, Springsteen said in a promo video shared on his social media accounts, “Our new film, Road Diary, will take you on a journey from behind the scenes at rehearsals to shows that we performed all around the world this year.

“You’ll get to experience a little bit of the fun and the magic that we get to experience every night.”

As for what 83-year-old journalist Tom Brokaw’s multiple myeloma means for Springsteen’s wife, it offers hope for the future.

Brokaw underwent effective maintenance therapy to help manage his symptoms of the incurable blood cancer and lead a good quality of life. His story certainly offers hope to Springsteen’s wife and others diagnosed with multiple myeloma. Brokaw was diagnosed with with multiple myeloma in 2013 and managed to work through his diagnosis until retiring in 2021 after 55 years of service. Additionally, his cancer journey led him to a breakthrough treatment that helped him manage his symptoms.

RELATED: When Multiple Myeloma Returns, SurvivorNet’s Resources

Brokaw received Revlimid (generic name lenalidomide), a breakthrough oral medication that has helped treat patients living with multiple myeloma. Combined with other therapies, standard doses of lenalidomide kill off myeloma cells.

WATCH: Journalist Tom Brokaw shares his multiple myeloma treatment.

Understanding Multiple Myeloma

Multiple myeloma is a rare and incurable type of blood cancer. When you have this 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. Those abnormal cells leave less room for the healthy blood cells your body needs to fight infections. They can also spread to other parts of your body and cause problems with organs like your kidneys.

Sometimes, doctors find multiple myeloma while doing a blood test to look for another condition or when trying to find out what’s causing a patient’s unexplained symptoms.

Doctors use blood and urine tests and imaging tests, such as X-rays or MRIs, to help diagnose multiple myeloma and to guide treatment options. Ultimately, a bone marrow biopsy will confirm the diagnosis.

Hematologist and SurvivorNet advisor, Dr. Nina Shah, helps you understand this rare cancer

Multiple myeloma symptoms can range from tiredness, nausea and constipation. Other symptoms may include:

• Weakness, dizziness, and shortness of breath, which are signs of a low red blood cell count, are called anemia.
• Bone pain, which could be a sign of a fracture.
• Urinating too much or too little, muscle cramps, nausea, and vomiting are symptoms of kidney failure.
• Confusion is caused by too much calcium in the blood.
• Frequent infections because you have too few white blood cells to fight them.

It’s important to know that these symptoms could be attributed to other conditions. If you experience any of these symptoms or are concerned about any changes to your body, you should address them promptly with your doctor.

Hematologist-oncologist Dr. Adam Cohen lays out your options during the maintenance phase of treatment

Getting a Diagnosis

Sometimes doctors find multiple myeloma while doing a blood test to look for another condition, or when trying to find out what’s causing a patient’s unexplained symptoms.

According to SurvivorNet’s experts, blood tests are also the way your doctor might learn that you have smoldering multiple myeloma or MGUS, because these conditions don’t usually cause symptoms. Smoldering multiple myeloma and MGUS aren’t cancer, but they can sometimes turn into cancer.

The odds that either condition will become cancer are very small, but to be safe, your doctor will probably check you more closely with blood and urine tests, and sometimes a bone marrow biopsy–removing and testing a small sample of the spongy material inside your bones. These tests can help monitor you for changes that signal you’ve switched over to multiple myeloma, and that you need to start treatment for this cancer. You may also need a bone marrow biopsy to help your doctor make the initial diagnosis.

Doctors use blood and urine tests and imaging tests such as X-ray or MRI to help diagnose multiple myeloma and to guide treatment options. Ultimately, a bone marrow biopsy will confirm the diagnosis.

Monitoring your bone strength and health over time will help your doctors understand how, or if, your disease is progressing.

Treatment Options For Multiple Myeloma

Not everyone with multiple myeloma needs treatment right away. If you have smoldering multiple myeloma, your doctor might simply monitor you regularly, to see if your disease progresses.

If you develop symptoms or your doctor thinks you need treatment, there are many options.  Which of these treatments you receive, and how they are sequenced, depend on several factors, and on whether your treatment team thinks you are a good candidate for a bone marrow transplant.

Bone Marrow (Stem Cell) Transplant

This is also known as a stem cell transplant. It is a procedure to replace diseased bone marrow with healthy bone marrow without myeloma cells. Based on multiple factors, your doctor may decide that a stem cell transplant is best for you. The transplant process can be involved and requires multiple steps. Be sure to discuss this with your treating team to understand what is involved and what options are available.

If you’re not a good candidate for chemotherapy, your treatment options include targeted therapies, biologics, and steroids.

Targeted Therapy

Targeted therapy is now available for patients with multiple myeloma, and targets abnormalities in myeloma cells that allow the cancer to survive. Examples of targeted agents your doctor may use include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Sarclisa). These drugs are either given in a pill or through an IV, and cause myeloma cells to die by preventing the breakdown of certain proteins in myeloma cells. You doctor may also use other targeted agents in the class of medications known as monoclonal antibodies.

Biologic Therapy

Biologic therapy is another class of medication your treatment team may use to treat your myeloma. These medications use your bodys immune system to help fight and kill myeloma cells. This class of medication is most often given in pill form and include medications such as thalidomide (Thalidomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst).

Chemotherapy

Sometimes your treatment team may recommend chemotherapy to treat your myeloma. Chemotherapy uses strong medicine to target cancer cells throughout your body. If your doctor recommends a bone marrow transplant high doses of chemotherapy are used for this purpose.

Steroids

Occasionally, doctors may use corticosteroids such as dexamethasone or prednisone as part of your treatment. Steroids are different from chemotherapy, targeted therapy, and biologic therapy. They work to reduce inflammation throughout your body. Steroids are given as a pill, and are also active against myeloma cells.

Radiation

Radiation uses high-dose X-rays to stop cancer cells from dividing. It is sometimes used to target myeloma in specific areas that may be causing you issues or pain. It is also used if there are tumors or deposits of myeloma cells that need to be treated, such as a plasmacytoma — a tumor made of abnormal plasma cells — of the bone.

Sometimes the cancer can return, or relapse after treatment. If this happens, your doctor can put you on one of the treatments you’ve already tried again, try a new treatment, or recommend that you enroll in a clinical trial.

Any of these treatments can cause side effects, which may include nerve pain and fatigue. Your doctor can adjust your medication if you do have side effects. In general, you should start to feel better once your treatment starts to work.

Extending Your Lifespan With Multiple Myeloma

Then you’ll ultimately reach the maintenance phase of treatment. Now that your doctor has gotten your cancer under control, from here the goal is to keep your disease stable and to maintain your quality of life. Which type of maintenance therapy you get, and what prognosis you can expect, will depend on whether your doctor determines that your multiple myeloma is standard risk or high risk.

One of SurvivorNet’s experts describes the maintenance process for this disease as similar to lawn care. Once you care for your lawn and it’s no longer overgrown (that’s the initial treatment), it will need some tending but with that attention (such as low doses of maintenance drugs), it can remain healthy.

Why the many phases of multiple myeloma are like caring for your lawn, says hematologic cancer specialist, Dr. Sid Ganguly

Sometimes this disease will return, even when you’re on maintenance therapies. You’ll still have treatments available if this happens.

Though it can be daunting to choose treatments for relapsed multiple myeloma, the medical experts at SurvivorNet are here to help you make sense of them. Remember that you do have options, and that the goal which becomes more achievable with each new treatment that’s introduced is to preserve your quality of life and extend your lifespan.

Questions for Your Doctor

If you are facing a multiple myeloma diagnosis, here are some questions to help you begin the conversation with your doctor:

• What stage is my multiple myeloma?
• What are my treatment options?
• Am I a good candidate for Revlimid?
• What are the possible side effects of your recommended treatment?
• Who will be part of my healthcare team, and what does each member do?
• Can you refer me to a social worker or psychologist who can help me cope with my diagnosis?

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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