Myeloma is the second most common type of blood cancer, accounting for around one percent of blood cancer cases. It develops in plasma cells, white blood cells that grow in bone marrow. Myeloma most often affects the aged — most cases are diagnosed in people age 65 and older. Although myeloma grows within bone, it is not considered bone cancer.
Listen as Gargi Upadhyaya, MD discusses multiple myeloma and the treatment options at City of Hope.
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Multiple Myeloma
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Learn more about Dr. Upadhyaya
Gargi Upadhyaya, MD, FACP
Specializing in hematology and medical oncology, Dr. Upadhyaya is board certified in internal medicine. She received her medical degree from Government Medical College, Surat, India. Her residency and hematology and oncology fellowships were completed at Los Angeles County USC Medical Center and City of Hope National Medical Center. She also served as a research fellow in the Hematology and Oncology Division of the Internal Medicine Department of the University of Michigan Medical Center. Dr. Upadhyaya has published articles in the Journal of Clinical Investigation, Blood, and Leukemia and is an active member of the American Society of Clinical Oncology (ASCO).Learn more about Dr. Upadhyaya
Transcription:
Multiple Myeloma
Melanie Cole (Host): Myeloma is the second most common type of blood cancer accounting for around 1% of blood cancer cases. This year, more than 30,000 people in the United States will be diagnosed with myeloma according to the American Cancer Society. My guest today is Dr. Gargi Upadhyaya. She’s an assistant clinical professor and specializing in hematology and medical oncology at City of Hope. Welcome to the show, Dr. Upadhyaya. Let’s talk about multiple myeloma and this debilitating malignancy. Explain what it is as a part of the spectrum of diseases.
Dr. Gargi Upadhyaya (Guest): Multiple myeloma is a diagnosis involving the bone marrow. The patient presents with pain, weight loss, shortness of breath, and fatigue.
Melanie: Okay, so if somebody is experiencing this – first of all, who is at risk for this type of myeloma?
Dr. Upadhyaya: Most of the time it’s an older patient in their 60s are at risk, but we’ve seen 3 to 5% of younger aged patients ranging from 30 to 50 years old also.
Melanie: So is there--
Dr. Upadhyaya: The majority of our patients are between 60 and 65 years old.
Melanie: And is there a genetic component to it?
Dr. Upadhyaya: There are no genetic components to the cancer itself that it doesn’t get given from one parent to the other or from parent to children. However, there are certain genetic tests that we do for myeloma to evaluate the aggressiveness of the disease.
Melanie: So who would get that genetic test and who would – you mentioned a few symptoms, but some of those symptoms sound very vague and like they could be many different things. What would send somebody to the doctor to get checked?
Dr. Upadhyaya: When a primary care physician finds a patient who has lost more than 10% of their body weight without trying, or they find – if you have anemia with a hemoglobin of less than 10 grams, their white count has gone down, or they are experiencing night sweats – night sweats as described being drenching sweats where they have to change their sheets, or their T-shirt while they’re sleeping – are common symptoms. There are people who also will get recurrent infections, so they would have either an upper respiratory infection, two months later they could have a sinus infection, the third month they could have a urinary tract infection, that’s when the primary care will say, “Something’s going on with this patient. We need to send them to a specialist.”
Melanie: So then, how is it diagnosed?
Dr. Upadhyaya: It’s diagnosed with a blood test, so when we see a patient, and we see they have anemia – white count is down, and they have the symptoms that I’ve just described – we order what we call a serum protein electrophoresis, and we also measure their immunoglobulin levels. Once we know and find out if their immunoglobulin level is high -- one of them would be high. There are four kinds of immunoglobulins – actually, there are five kinds, but we look at the three main. One is called IgG, the second one is IgA, and the third is IgE and IgM. We pay attention mainly to the G, A, and M part of the immunoglobulins. If one is very high and the others are low, it increases the suspicion for multiple myeloma. On the protein electrophoresis, we’ll see an abnormal quote-unquote band of protein, which tells us that this doesn’t belong here and this is why the person is having symptoms.
The other thing we look for is whether the person has kidney failure and/or if they are anemic. If that is what we get on the preliminary blood tests, then we move onto further testing, which includes doing a bone marrow biopsy and we do further blood tests with certain genetic tests and also request genetic tests on the bone marrow, which are called the CD38 mutation, p53 mutation, and other deletions of certain chromosomes, which, depending on what the person has will tell us how severe the myeloma is and whether or not we should treat them aggressively or with standard treatments versus going for a transplant. It gives us an indication of how to go about with the treatment.
We also order X-rays of the whole body, which is from skull to toe because multiple myeloma tends to cause what we call pathological lytic fractures in the bone, especially in the long bone and on the skull. If the patients have that, that also confirms the diagnosis. We don’t need to biopsy the bone, but with the blood picture and the X-ray picture, we’ll get a confirmation.
Melanie: So if you get a confirmation from all of these tests, is this cancer that is curable? Is it cancer that requires as you mentioned, possibly aggressive treatment? What does the prognosis look like and what does the treatment look like?
Dr. Upadhyaya: At this time, multiple myeloma is very, very treatable. Unfortunately, it’s not curable. However, the treatment is not very aggressive. We can treat them with a medication called Velcade -- which is an injection that’s given under the skin -- twice a week for two weeks, and then we give them a week off. We do that for four times and repeat the bone marrow biopsy. If the patient has any lesions in the bone, then we will give them a medicine called Zometa to strengthen the bone. Zometa is given once a month. If they go into remission depending on the patient’s age, if they are older – older meaning older than 70 years old, which is the cutoff for transplant – we will put them on maintenance therapy of Velcade or a pill called Revlimid for maintenance. If they are younger – younger than 70 -- and they’ve gone into what we call a complete remission, that means that the bone marrow now has less than 5% of the myeloma cells, then we send them for evaluation for a bone marrow transplant.
Bone marrow transplant doesn’t mean that it is taking their bone marrow – I’m sorry, not giving bone marrow from somebody else. However, it is taking the stem cells from the patient himself, or herself, freezing these cells, then giving more extensive chemotherapy, reinfusing the stem cells and allowing the healthy stem cells to grow in a person’s body. This is called an autologous transplant, and the chances of survival with an autologous transplant are much higher, and the patients have less side-effects because it is not somebody else’s marrow. In younger than 70-year-old patients we recommend doing a transplant after they achieve remission so they can stay in remission for more than ten years.
Melanie: That’s fascinating Dr. Gargi, and what about things that you’re doing there at City of Hope in terms of immunotherapy or targeted therapies? Are any of these useful for multiple myeloma?
Dr. Upadhyaya: At this point, there’s not targeted therapy for multiple myeloma, but we will eventually have them. We have some clinical trials going on. The results are not out yet, but we try to give our patients the option of enrolling into trials as soon as we think they are eligible for it. It gives them a second option. These are not experimental medicines. We know that these medicines work in myeloma, but we need to sometimes prove that this medicine is better than the standard of care is one purpose of doing the trial. The second would be to see if the medicine is helpful with fewer side-effects than the standard therapy. There are many reasons for doing the trial, and we’ve had a lot of success with the clinical trials, and unofficially I can say we have seen a lot of people living longer, but the trials have not been published yet, so we will have a better idea as soon as the trials get published.
Melanie: So wrap it up for us, with people who may have been diagnosed with multiple myeloma and living with it, what would you like them to know, Dr. Gargi, about managing side-effects, or pain management, or just staying healthy and active while they go through these types of treatments.
Dr. Upadhyaya: The one thing I tell my patients about multiple myeloma is you keep moving. The more you move, the myeloma will not catch up with you. It is a treatable disease. You live a long, normal life. It’s almost like a chronic disease, which is less debilitating than diabetes, or hypertension, or arthritis, so a person who can exercise should exercise. Stay away from sick people – not that you don’t go near them, but just use common sense. Wash your hands when you touch somebody who is sick, don’t share a drink. It’s common sense stuff that you do.
And once you’re in remission and you’re not on any therapy, you live a normal life. You live your life and just get checked every three months, and there are very few chances that this comes back in the first couple of years. Usually, I’ve seen them come back after five, ten years. I’ve had patients living for 20, 25 years and a healthy lifestyle and a healthy life, good quality of life, traveling around the world, doing everything with their kids and grandkids. Even though this is a diagnosis of cancer, it’s not a dismal prognosis. People live a good life. They live a normal life. Yes, while they are on treatment, it may be a little difficult, but these treatments are very tolerable. Side effects are very manageable, especially if you exercise and keep moving.
Melanie: Thank you, so much, Dr. Gargi, that’s really great information and so important and hopeful for listeners to hear. You’re listening to City of Hope Radio, and for more information, you can go to CityOfHope.org, that’s CityOfHope.org. This is Melanie Cole. Thanks, so much, for listening.
Multiple Myeloma
Melanie Cole (Host): Myeloma is the second most common type of blood cancer accounting for around 1% of blood cancer cases. This year, more than 30,000 people in the United States will be diagnosed with myeloma according to the American Cancer Society. My guest today is Dr. Gargi Upadhyaya. She’s an assistant clinical professor and specializing in hematology and medical oncology at City of Hope. Welcome to the show, Dr. Upadhyaya. Let’s talk about multiple myeloma and this debilitating malignancy. Explain what it is as a part of the spectrum of diseases.
Dr. Gargi Upadhyaya (Guest): Multiple myeloma is a diagnosis involving the bone marrow. The patient presents with pain, weight loss, shortness of breath, and fatigue.
Melanie: Okay, so if somebody is experiencing this – first of all, who is at risk for this type of myeloma?
Dr. Upadhyaya: Most of the time it’s an older patient in their 60s are at risk, but we’ve seen 3 to 5% of younger aged patients ranging from 30 to 50 years old also.
Melanie: So is there--
Dr. Upadhyaya: The majority of our patients are between 60 and 65 years old.
Melanie: And is there a genetic component to it?
Dr. Upadhyaya: There are no genetic components to the cancer itself that it doesn’t get given from one parent to the other or from parent to children. However, there are certain genetic tests that we do for myeloma to evaluate the aggressiveness of the disease.
Melanie: So who would get that genetic test and who would – you mentioned a few symptoms, but some of those symptoms sound very vague and like they could be many different things. What would send somebody to the doctor to get checked?
Dr. Upadhyaya: When a primary care physician finds a patient who has lost more than 10% of their body weight without trying, or they find – if you have anemia with a hemoglobin of less than 10 grams, their white count has gone down, or they are experiencing night sweats – night sweats as described being drenching sweats where they have to change their sheets, or their T-shirt while they’re sleeping – are common symptoms. There are people who also will get recurrent infections, so they would have either an upper respiratory infection, two months later they could have a sinus infection, the third month they could have a urinary tract infection, that’s when the primary care will say, “Something’s going on with this patient. We need to send them to a specialist.”
Melanie: So then, how is it diagnosed?
Dr. Upadhyaya: It’s diagnosed with a blood test, so when we see a patient, and we see they have anemia – white count is down, and they have the symptoms that I’ve just described – we order what we call a serum protein electrophoresis, and we also measure their immunoglobulin levels. Once we know and find out if their immunoglobulin level is high -- one of them would be high. There are four kinds of immunoglobulins – actually, there are five kinds, but we look at the three main. One is called IgG, the second one is IgA, and the third is IgE and IgM. We pay attention mainly to the G, A, and M part of the immunoglobulins. If one is very high and the others are low, it increases the suspicion for multiple myeloma. On the protein electrophoresis, we’ll see an abnormal quote-unquote band of protein, which tells us that this doesn’t belong here and this is why the person is having symptoms.
The other thing we look for is whether the person has kidney failure and/or if they are anemic. If that is what we get on the preliminary blood tests, then we move onto further testing, which includes doing a bone marrow biopsy and we do further blood tests with certain genetic tests and also request genetic tests on the bone marrow, which are called the CD38 mutation, p53 mutation, and other deletions of certain chromosomes, which, depending on what the person has will tell us how severe the myeloma is and whether or not we should treat them aggressively or with standard treatments versus going for a transplant. It gives us an indication of how to go about with the treatment.
We also order X-rays of the whole body, which is from skull to toe because multiple myeloma tends to cause what we call pathological lytic fractures in the bone, especially in the long bone and on the skull. If the patients have that, that also confirms the diagnosis. We don’t need to biopsy the bone, but with the blood picture and the X-ray picture, we’ll get a confirmation.
Melanie: So if you get a confirmation from all of these tests, is this cancer that is curable? Is it cancer that requires as you mentioned, possibly aggressive treatment? What does the prognosis look like and what does the treatment look like?
Dr. Upadhyaya: At this time, multiple myeloma is very, very treatable. Unfortunately, it’s not curable. However, the treatment is not very aggressive. We can treat them with a medication called Velcade -- which is an injection that’s given under the skin -- twice a week for two weeks, and then we give them a week off. We do that for four times and repeat the bone marrow biopsy. If the patient has any lesions in the bone, then we will give them a medicine called Zometa to strengthen the bone. Zometa is given once a month. If they go into remission depending on the patient’s age, if they are older – older meaning older than 70 years old, which is the cutoff for transplant – we will put them on maintenance therapy of Velcade or a pill called Revlimid for maintenance. If they are younger – younger than 70 -- and they’ve gone into what we call a complete remission, that means that the bone marrow now has less than 5% of the myeloma cells, then we send them for evaluation for a bone marrow transplant.
Bone marrow transplant doesn’t mean that it is taking their bone marrow – I’m sorry, not giving bone marrow from somebody else. However, it is taking the stem cells from the patient himself, or herself, freezing these cells, then giving more extensive chemotherapy, reinfusing the stem cells and allowing the healthy stem cells to grow in a person’s body. This is called an autologous transplant, and the chances of survival with an autologous transplant are much higher, and the patients have less side-effects because it is not somebody else’s marrow. In younger than 70-year-old patients we recommend doing a transplant after they achieve remission so they can stay in remission for more than ten years.
Melanie: That’s fascinating Dr. Gargi, and what about things that you’re doing there at City of Hope in terms of immunotherapy or targeted therapies? Are any of these useful for multiple myeloma?
Dr. Upadhyaya: At this point, there’s not targeted therapy for multiple myeloma, but we will eventually have them. We have some clinical trials going on. The results are not out yet, but we try to give our patients the option of enrolling into trials as soon as we think they are eligible for it. It gives them a second option. These are not experimental medicines. We know that these medicines work in myeloma, but we need to sometimes prove that this medicine is better than the standard of care is one purpose of doing the trial. The second would be to see if the medicine is helpful with fewer side-effects than the standard therapy. There are many reasons for doing the trial, and we’ve had a lot of success with the clinical trials, and unofficially I can say we have seen a lot of people living longer, but the trials have not been published yet, so we will have a better idea as soon as the trials get published.
Melanie: So wrap it up for us, with people who may have been diagnosed with multiple myeloma and living with it, what would you like them to know, Dr. Gargi, about managing side-effects, or pain management, or just staying healthy and active while they go through these types of treatments.
Dr. Upadhyaya: The one thing I tell my patients about multiple myeloma is you keep moving. The more you move, the myeloma will not catch up with you. It is a treatable disease. You live a long, normal life. It’s almost like a chronic disease, which is less debilitating than diabetes, or hypertension, or arthritis, so a person who can exercise should exercise. Stay away from sick people – not that you don’t go near them, but just use common sense. Wash your hands when you touch somebody who is sick, don’t share a drink. It’s common sense stuff that you do.
And once you’re in remission and you’re not on any therapy, you live a normal life. You live your life and just get checked every three months, and there are very few chances that this comes back in the first couple of years. Usually, I’ve seen them come back after five, ten years. I’ve had patients living for 20, 25 years and a healthy lifestyle and a healthy life, good quality of life, traveling around the world, doing everything with their kids and grandkids. Even though this is a diagnosis of cancer, it’s not a dismal prognosis. People live a good life. They live a normal life. Yes, while they are on treatment, it may be a little difficult, but these treatments are very tolerable. Side effects are very manageable, especially if you exercise and keep moving.
Melanie: Thank you, so much, Dr. Gargi, that’s really great information and so important and hopeful for listeners to hear. You’re listening to City of Hope Radio, and for more information, you can go to CityOfHope.org, that’s CityOfHope.org. This is Melanie Cole. Thanks, so much, for listening.