Learning about Multiple Myeloma
- Corey Anderson is a 43-year-old father of four battling multiple myeloma. His diagnosis arrived after months of having leg and hip pain. He initially thought the pain was due to his fitness level because he had recently started working out when the pain first arrived.
- Multiple myeloma is a blood cancer involving plasma cells a certain kind of mature white blood cell in the bone marrow that helps fight infection. This cancer can lead to things like fatigue, bone fractures and kidney damage.
- Symptoms of multiple myeloma can vary but one of our experts spoke about patients feeling tired or noticing they were getting more infections than usual before their diagnosis. In addition, bone problems like pain or weakness in the back, hips or skull are other symptoms to look out for with multiple myeloma.
- The first phase of treatment you will undergo after a multiple myeloma diagnosis is called induction therapy. The goal of this therapy is to reduce the number of myeloma cells within your bone marrow in preparation of a stem cell transplant (if you're eligible). The specific drugs used and the number of drugs used can vary from case to case, but VRD a triple regimen of Bortezomib (Velcade), Lenalidomide (Revlimid) and Dexamethasone is the standard. Still, some doctors add a fourth drug to the regimen.
- Maintenance therapy is the last stage of multiple myeloma treatment meant to keep the cancer under control after you've had other forms of treatment. According to one of our experts, studies of maintenance therapy for patients who have had autologous stem cell transplantation suggest that Revlimid shows the most benefit.
Corey Anderson and his wife Janelle Anderson began a new routine of working out in April 2022. So, the 43-year-old father of four thought the pain that arrived shortly after had to do with his level of fitness.
Read MoreMonths went by with Corey’s pain coming and going. When the summer rolled around, he was determined to address it.@disadventurelife Replying to @user948025196 first symptoms of my husbands cancer #mm #myeloma #firstsigns #cancerawareness ♬ original sound – Disadventurelife
“Over the summer, he was like, ‘I’m going to go to the chiropractor,'” she explained. “The chiropractor was like, ‘Oh you have one leg longer than the other, I’m gonna be able to fix you up real quick.'”
Corey went to see the chiropractor for adjustments three times a week for about six to eight weeks. Sadly, his pain did not subside.
“Although some of the pain in his back did get a little better, the pain in his hip got much, much worse,” Janelle said. “By the time October rolled around, he couldn’t walk anymore.
“So, that’s when I was like, ‘Hey this isn’t getting better, you should go see a doctor and maybe have an X-Ray taken.’ By the way cancer was the furthest thing in our mind at this point, I was just thinking maybe he fractured his hip.”
Tom Brokaw spoke to SurvivorNet about his experience with multiple myeloma.
The X-Ray revealed that there was “something” on Corey’s hip. So, doctors recommended he see an oncologist for an MRI.
“We get the MRI done, and it comes back that there’s a giant tumor that has eaten away at his entire right hip and pelvis,” Janelle explained. “And they immediately say he’s at very high risk of breaking his bones and needs to be on crutches and a scooter.”
Once Corey underwent a biopsy, doctors confirmed his tumor was, in fact, malignant (cancerous). Following more testing and scans, he was eventually given his multiple myeloma diagnosis.
For treatment, Corey recently began having radiation, but it’s unclear what his next steps will be after that.
“This is a long road to recovery and we are looking forward to Corey walking again,” reads an update from the GoFundMe page Corey’s sister set up for him. “To be 43 years old and have this type of scary life interruption has been surreal.”
View this post on Instagram
Janelle has continued to share updates about Corey’s journey on her Instagram and TikTok pages. And a big emphasis for her is to encourage others to seek medical attention when changes to their health occur.
“Truly there were no other symptoms,” she said of her husband’s cancer. “No weight loss, no fatigue, nothing else that would have even put cancer in our mind. So, for 9 months he had cancer if not longer.”
Understanding Multiple Myeloma
Multiple myeloma is a type of blood cancer involving plasma cells a certain kind of mature white blood cell in the bone marrow that helps fight infection by producing proteins that help your immune system fend itself against germs. So, in order to understand multiple myeloma, it's important to talk about the bone marrow.
What Is a Blood Cancer How Is It Different?
"The bone marrow is the factory that makes all of the cells that wind up in our bloodstream," Dr. Mikkael Sekeres, the chief of the Division of Hematology at the University of Miami Sylvester Comprehensive Cancer Center, previously told SurvivorNet.
The bone marrow makes red blood cells which bring oxygen to our tissues, white blood cells which fight infections and platelets which help stop bleeding. For people with multiple myeloma, cancerous plasma cells, or myelomas, grow uncontrollably in the bone marrow and crowd out healthy white blood cells. This, in turn, inhibits the immune system's ability to fight off infection which leads to fatigue.
Eventually, the myelomas grow too large in the bone marrow which can cause bone fractures. Myelomas can also lead to kidney damage because these cancerous cells release abnormally high levels of antibodies into the bloodstream which eventually build up in the kidney since its unable to process these extra proteins.
University of California at San Francisco hematologist-oncologist Dr. Nina Shah spoke with SurvivorNet about some of the symptoms of multiple myeloma.
"It's very common for someone to say, 'You know, I've been feeling very tired," or 'You know, I notice I had a few more infections last winter than I remember,’" Dr. Shah said. "But at the first sign of something abnormal, it's important to then take that to the next step and say, 'OK, what am I missing? Is there something else maybe that could be causing this?' And that's often when we see a diagnosis of multiple myeloma."
In addition, bone problems like pain or weakness in the back, hips or skull are other symptoms to look out for with multiple myeloma.
Dr. Shah says cases of multiple myeloma can be grouped into categories that help physicians decide on the appropriate courses of treatment.
"We tend to [divide them] based on how risky the myeloma is, whereas other cancers will be staged based on how far the cancer has spread," Dr. Shah previously told SurvivorNet.
The three stages of myeloma include the following:
- High risk multiple myeloma when a patient's cells contain missing segments of DNA or switched segments.
- Intermediate risk multiple myeloma when some of these DNA changes are not present but a patient has elevated levels of certain proteins in the blood.
- Low risk multiple myeloma when a patient has none of these changes.
Technically, there is no cure for this disease, but recent advances in medicine have made room for hope especially with early diagnoses.
"This is still considered an incurable disease," Dr. Shah said. "But we want to make sure we make people understand that it's a disease that you can live with not necessarily have to die of."
Multiple Myeloma Treatment
Following a multiple myeloma diagnosis, the first phase of treatment you will undergo is called induction therapy. The goal of this therapy is to reduce the number of myeloma cells within your bone marrow in preparation of a stem cell transplant (if you're eligible). But how many drugs are used and which ones are chosen can vary from case to case.
The Induction Phase of Multiple Myeloma Treatment: What Are the Options?
Oftentimes, you'll receive a combination of multiple drugs. According to Dr. Tareq Al Baghdadi, a medical oncologist and hematologist at St. Joe's Mercy Hospital in Ann Arbor, Michigan, the triple regimen of VRD is the "standard."
- Bortezomib (Velcade) a proteasome inhibitor
- Lenalidomide (Revlimid) an immunomodulatory drug
- Dexamethasone a steroid
RELATED: Treating the Side Effects of Induction Therapy
There are other combinations such as VCD substitute cyclophosphamide (Cytoxan) for Revlimid.
"Over the years, we've noticed that triplet regimens give us deeper and longer responses compared to doublet regimens," Dr. Al Baghdadi explained.
But some doctors even add a fourth drug the monoclonal antibody daratumumab (Darzalex) into the mix.
"With regards to induction therapy, three versus four drugs, there's early data now showing that you achieve deeper responses when when you use four drugs versus three drugs, but whether that's gonna lead to survival advantage remains to be seen and specifically which subgroup of patients will achieve that advantage," Dr. Al Baghdadi said. "Is a four drug regimen preferable in high risk patient versus low risk patients or standard risk patients versus both? That's what the current clinical trials are assessing."
According to Dr. Al Baghdadi, some institutions have already moved to using daratumumab as part of a four-drug standard initial therapy, while others stick to the three-drug regiment.
Following induction therapy, some multiple myeloma patients will have a stem cell transplant if they're eligible.
"Eligibility can be determined by comorbidities… things like heart issues, lung issues, kidney issues, functional capacity and also age," Dr. Al Baghdadi explained.
Dr. Al Baghdadi's specific hospital doesn't offer stem cell transplants, but that doesn't mean his patients don't receive them.
"We refer those patients out," he said. "So, when applicable for eligible patients, we induce them, send them out to one of two institutions nearby, they get transplanted and then come back."
Most eligible patients do have a stem cell transplant, according to Dr. Al Baghdadi.
"The value of transplant has been established for many years now," he said. "And despite improvement in induction therapy and systemic therapy, there's still a role for autologous stem cell transplant."
Still, Dr. Al Baghdadi did say that achieving long-term remission is still possible without a stem cell transplant.
"We see those patients every day," he said. "We currently give treatments to those patients in phases induction and their maintenance. And I can think of many patients that have entered a complete remission and remain in complete remission. And that's partly determined by the type of treatment they get and the type of multiple myeloma they have in terms of the risk stratification whether it's standard-risk myeloma or high-risk myeloma."
After induction and a stem cell transplant (if you end up having one), the next step for a multiple myeloma patient is maintenance therapy. Maintenance therapy is the last stage of multiple myeloma treatment meant to keep the cancer under control after you've had other forms of treatment.
How Does Maintenance Therapy for Multiple Myeloma Work?
"With regards to maintenance therapy in multiple myeloma patients, this is mainly studied in patients who have had autologous stem cell transplantation, and there's been multiple clinical trials looking at different medications over the years," Dr. Al Baghdadi said. "And the one that showed the most benefit and considered standard of care at this time is Revlimid. This is especially the case in standard-risk patients who can go on two years of Revlimid, and, with that, achieve an improvement in disease control and survival."
RELATED: Which Drugs Are Used for Multiple Myeloma Maintenance Therapy?
Maintenance therapy is also used in some patients who have not had stem cell transplants and the amount of time a person is on the drugs will depend on their individual disease and any progression.
Revlimid is the brand name for the immunomodulatory drug lenalidomide. An immunomodulatory drug is used to modify a person's immune system response. Revlimid, in particular, is also commonly seen as part of a multiple myeloma patient's induction therapy which occurs prior to maintenance therapy.
But Revlimid is not the only maintenance therapy drug option. For high-risk multiple myeloma patients, for example, Dr. Al Baghdadi has seen that another drug can be a suitable option.
RELATED: How Are Patients Monitored After Multiple Myeloma Treatment?
"The quality of the data in [higher-risk] patients is not as good as the data with Revlimid, but data in high risk patients also show that a drug like Velcade can improve disease control and survival," he said. "So you'll see some patients going on maintenance with Velcade and occasionally with both drugs, Velcade and Revlimid."
Dr. Al Baghdadi also explained that maintenance therapy does not have a specific time limit. Some patients are only on a certain medication(s) for a couple years and others are on it/them indefinitely, and there are ongoing trials right now working to compare two years of maintenance therapy versus maintenance therapy until progression meaning continued use of the drug(s) for as long as the myeloma is under control. No matter what, you should talk with your doctor and explore your options. Remember, maintenance therapy like most any cancer treatment is not a one size fits all.
Multiple Myeloma: How Are Patients Monitored after Treatment?
Learn more about SurvivorNet's rigorous medical review process.
