Newly Diagnosed with Myeloma? 

Whether you were diagnosed a week ago or six months ago, there is so much to learn about your disease. Multiple myeloma is a complex cancer with many treatment strategies and side effects. Dr. Jason Chen, from the Ann Arbor VA Medical Center and a clinical assistant professor at the University of Michigan, provides valuable information regarding patient care, staging and survival rates, and symptoms and side effects of myeloma treatment.

Common Patient Scenario

Patients often visit their doctor due to unexplained pain. Abnormal results frequently show from imaging and blood tests, and the patient is then referred to a hematologist. A bone marrow biopsy and PET scan are commonly performed to look for plasma cells and lytic lesions. Multiple myeloma is diagnosed, and a treatment plan is put into place.

Multiple Myeloma

Myeloma is the 2nd most common blood cancer (after lymphoma) caused by abnormal plasma cells that secrete M-protein (monoclonal protein) into the blood or urine. It is not considered curable, but treatments can prolong life and provide optimal survival. Research is continuously ongoing, and effective treatments are being defined.

See: What Is Multiple Myeloma

Staging

Myeloma is not traditionally staged with a 1-4 system. Instead, the R-ISS (Revised International Staging System) is used, based on various blood tests and genetic mutations found from a bone marrow biopsy. A score of 1-3 is assigned, which helps to identify the low to high risk of the disease.

See: What Are The Stages Of Multiple Myeloma

Survival

Life expectancy with myeloma is dependent on several factors: 

• Whether the patient is low or high risk.
• Treatment received. 
• A patient’s age. 
• If any comorbidities are present (heart disease, diabetes). 
• Whether or not the patient is eligible for a stem cell transplant.

If a patient is not high-risk, survival rates can range from 5-10+ years. For high-risk patients, depending on each individual case, survival can be 5 years or less.

Side Effects Of Myeloma

CRAB is a helpful acronym to remember:

• C- Calcium levels that are too high (tremors, palpitations, weakness).
• R- Renal (kidney) injury (swelling, urine changes).
• A- Anemia (low blood count) will cause fatigue and may require transfusions.
• B- Bone lesions (pain and fractures).

See: Multiple Myeloma Signs And Symptoms

Common Treatment Combinations

RVD: Bortezomib (Velcade) + Lenalidomide (Revlimid) + Dex

DRD: Daratumumab (Darzalex) + Lenalidomide (Revlimid) + Dex

CyBorD: Cyclophosphamide (Cytoxan) + Bortezomib (Velcade) + Dex

DaraRVD: Daratumumab (Darzalex) + Bortezomib (Velcade) + Lenalidomide (Revlimid) + Dex

The standard of care for most newly diagnosed patients should include a 3-4 drug combination.

Treatment Side Effects

Lenalidomide (Revlimid): rash, diarrhea, low blood counts, blood clots.

Bortezomib (Velcade): nausea, diarrhea, rash, neuropathy, low blood counts, risk of shingles.

Dexamethasone: swelling, high blood sugar, high blood pressure, anxiety, insomnia, skin thinning.

Daratumumab (Darzalex): mild infusion reactions, blood typing issues.

Cyclophosphamide (Cytoxan): fatigue, nausea, low blood count.

Receiving Supportive Care medications can help, especially for bone health: Denosumab (Xgeva) and Zoledronic acid (Zometa). Palliative radiation can help with bone lesions.

See: Understanding Multiple Myeloma Treatment Side Effects.

Recommended

Stem Cell Transplant should always be considered. A patient must be evaluated and determined to be in a healthy state to receive a transplant.

Patient questions begin at video time mark, 28:12

For any further questions or concerns, you can read our guide for Newly Diagnosed Patients or visit HealthTree University.