Jaime Lewis (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today, I'm sitting down with Medical Oncologist, Dr. Kathleen Elliott, and we're going to be talking about multiple myeloma. Before we get started, Dr. Elliott, I'm curious how blood cancer became a passion of yours and what made you want to become a cancer physician?

Dr. Kathleen Elliott: Absolutely. It's a pleasure to be here. My passion for blood cancers, particularly multiple myeloma, began during my medical training when I encountered patients who despite having the daunting diagnosis, displayed resiliency and hope. And I was inspired by their strength and felt a strong calling to contribute to this field.

 Additionally, losing my sister to cancer also deeply motivated me to pursue a career where I could make a tangible difference in patients' lives. This field allows me to merge my scientific interests with compassionate patient care, striving to extend and improve the quality of life for those patients that are battling blood cancers.

Host: I love how personal that is for you. Well, let's talk about multiple myeloma. So what exactly is it?

Dr. Kathleen Elliott: Multiple myeloma is a type of blood cancer that originates in the bone marrow, specifically plasma cells. They are a type of white blood cells that are responsible for producing antibodies that help with our immune function. So in multiple myeloma, these plasma cells become malignant and they proliferate. So they just continue to divide and that can lead to various health issues as compromised immune function, anemia, which is a low hemoglobin, kidney failure and bone disease. It's a relatively rare cancer, but it does pose significant challenges too due to its impact on multiple systems in the body.

Host: And how is it detected?

Dr. Kathleen Elliott: It's usually detected through a combination of blood tests, urine tests, and a bone marrow biopsy. So blood tests can reveal abnormal levels of protein that's produced by these myeloma cells known as M proteins or monoclonal proteins. And then imaging studies like x-rays, MRIs, or CT scans may be used to identify bone lesions, or bone damage. The way to define the diagnosis is through a bone marrow biopsy to examine the presence of abnormal plasma cells.

Host: How has the treatment for multiple myeloma changed over the years?

Dr. Kathleen Elliott: So the treatment of multiple myeloma has evolved significantly over the last several years. Historically, options were limited to conventional chemotherapy, which often had severe side effects. So today we have a range of targeted treatments, immunotherapies, and advanced chemotherapy options that are more effective and better tolerated. In addition, stem cell transplants also is used in the treatment of multiple myeloma for patients that are eligible, which offers a potential longer remission period.

Host: When you're speaking with your patients, what is one of the bigger concerns or objections they may have and how do you ease their concerns?

Dr. Kathleen Elliott: So one of the biggest concerns patients have is truly the fear of the unknown and the potential side effects of treatment. They worry about how their quality of life will be affected and the impact on their families. To ease their concerns, I spend a lot of time educating patients about their conditions and the treatment process.

And I provide information on what to expect, try to manage side effects proactively. And at our cancer center, we have the ability to offer support through counseling services. And we also have support groups that I encourage my patients to participate in.

Host: Absolutely. Well, I'd love to get a quick overview of what treatment looks like. Can you explain how a stem cell transplant works? Does everyone need one?

Dr. Kathleen Elliott: So treatment for multiple myeloma typically involves a combination of therapies, including chemotherapy, targeted therapy, and immunotherapy. And when I see a patient for the first time, I approach them as, are they eligible for a stem cell transplant or are they not? And so for patients that are eligible for a stem cell transplant, that becomes a vital plan of their treatment plan. And it's based on a combination of age and their performance status means how fit they are and their comorbidities, meaning other medical problems that they have besides the cancer. And so usually patients receive chemotherapy up front and then as they get ready for the stem cell transplant, we collect stem cells from the patient and then we administer high doses of chemotherapy to get rid of the cancerous cells, and then we re-infuse the healthy cells to help rebuild the patient's bone marrow.

Again, not everyone needs a stem cell transplant. It depends on factors like their age, overall health. And we try to personalize each patient's treatment plan to achieve the best possible outcome.

Host: That is fascinating. Is treatment moving to more of an outpatient basis with these changes? How is Novant Health on the leading edge of this kind of work?

Dr. Kathleen Elliott: Yeah, so there's a significant shift towards outpatient treatment for multiple myeloma. And advances in therapy and support care have made it possible for patients to receive treatment in the outpatient setting, reducing the needs for prolonged hospital stay. This approach not only improves the quality of life for patients by allowing them to stay at home, but it reduces health care costs.

And outpatient treatment options include oral medications, subcutaneous injections, and infusions that can be administered in the outpatient clinic. I work at Forsyth Medical Center, but at our sister hospital in Charlotte, they're now doing their stem cell transplants for eligible patients in the outpatient setting. And so Novant has a commitment to providing our patients with cutting edge research, advanced treatment protocol, and comprehensive patient care.

Host: Well, of course, more research is needed to find a cure, but what encourages you the most about the direction that we're headed?

Dr. Kathleen Elliott: So what encourages me the most is the rapid pace of advancement in our understanding of multiple myeloma and the developments of new treatments. The emergence of targeted therapies, immunotherapies, and novel drug combinations have significantly improved patients outcomes and their quality of life.

 The ongoing research and clinical trials hold great promise for finding more effective treatments and ultimately a cure. And Novant is committed to that, and we have several clinical trials available at our institutions for patients.

Host: Fascinating. Well, thank you, Dr. Elliott, for sharing all your expertise and your experience with us.

Dr. Kathleen Elliott: Thank you.

Host: Once again, that was Dr. Kathleen Elliott. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And thanks for joining us.