What is multiple myeloma?

What is multiple myeloma?

Multiple myeloma is a blood disorder that is thought to originate from plasma cells. It's a disease that happens in about 30,000 Americans every year. There are more than 120,000 Americans living with the disease. In updated 2023 myeloma statistics. About 35,000 new cases happened in the United States and about 160,000 Americans are living with myeloma. It is a disease that can present itself in very many different ways. Some patients can have the disease without being really that sick. And some patients, unfortunately, can have a very rapid disease process. The disease can manifest in fractures. It can manifest in high levels of calcium in the body that makes the person very sick. And it can result in acute kidney failure. That can be due to both the calcium and protein that the disease also leaks out in the blood. When we study the disease in the laboratory and we have sort of using very sophisticated assays when we do profiling of the DNA and RNA, we see that every patient with myeloma has very many alterations genomically. We have seen that there are many, many parallel subtypes of myeloma going on at the same time in that same patients and it's different across different patients. I do think when we treat patients with multiple myeloma, we know best treatments. I strongly believethat we probably cure the patient from some of these subsets of the disease, but there are some subsets of the disease that we don't get rid of, unfortunately, and we are working on that. So when we follow patients over time, when the disease comes back, those subsets can come back and they can be more aggressive. It may not happen at the first relapse, but it could happen at later relapses. Multiple myeloma is a cancer of a white blood cell called a plasma cell. I tell them that normal plasma cells reside in the bone marrow and are responsible for producing antibodies to fight off infection and death. One of these plasma cells develops the right set of mutations and chromosome alterations that it will. Unfortunately start to grow out of control and increasingly occupy the bone marrow. And when that happens, then we start to see some of the manifestation that we typically think of with multiple myeloma. The myeloma starts to overgrow the bone marrow. We see anemia. Those myeloma cells are sending signals to bone breaking down cells to break down bone. So you start to see bone damage. You see the calcium leaching out of the bone leading to high levels of calcium in the bloodstream. And, you know, even though these plasma cells are cancerous, they're still making antibody. And occasionally those antibodies, especially light chain antibodies, can deposit the kidney and cause kidney damage. What Dr. Voorhees has just described is known as the CRAB criteria or symptoms of myeloma. Calcium builds up in the blood, causing hypercalcemia or too much calcium. Renal or kidney disease can be caused by a buildup of antibodies produced by the cancerous myeloma plasma cells. Anemia can develop as red blood cells get crowded out by those proliferating cells, and bone damage can develop from too much breaking down of the bone caused by the myeloma cells. I think it's important for all patients to understand that while we don't necessarily view multiple myeloma as curable, at least for the majority of patients. I think that the therapy has become increasingly effective. The overwhelming majority of patients will respond to treatment, and particularly for those patients who have standard risk disease, that initial remission can last many years. Myeloma is a cancer of the immune system. It's a cancer of a very particular type of component of the immune system, the so-called plasma cell. And I'm biased, but I consider her the queen of the immune system because plasma cells are remarkably sophisticated. They really know what they're doing. They've got tremendous mechanism for memory, for regeneration, for dormancy, waking up and doing all sorts of amazing things when we're infected. And we need an immune system that responds to a bug. The challenges when that goes malignant and the queen becomes a bad queen, we are in real trouble. And the plasma cell produces lots of redundant protein because it's not doing the right thing. And these cells grow cleverly but uncontrollably and in that context can cause tremendous organ damage and at the same time can attack bone, the bone marrow, cause infections because they suppress normal immune system components and at the same time attack the kidney, generating a high level of protein that can also in turn thicken the blood. And this can result in all sorts of manifestations. Most important of all is that they make patients very symptomatic and the patients feel tired, exhausted, flu like bone pain. It really has a whole spectrum of effects that make people feel really lousy. And so in that setting, not only is it very dangerous, but it makes people feel very, very ill as well. And in that context, therefore, initial treatment for active disease is very important. And obviously that's a mainstay of what we do in myeloma treatment. So multiple myeloma is the cancer of plasma cells. So plasma is one type of white blood cell that helps our body fight infection. And why the plasma cell becomes cancerous, we don't quite understand, but we feel that there is probably some genetic component and significant environmental component that makes these plasma sets become abnormal. Now, just the abnormality in the plasma by itself is not very uncommon, especially in the older patients. Almost 5 to 6% of patients over 70 might have enough normal clone of plasma cells that makes it more protein. But the majority of the people, it is not focused on myeloma, So they are still trying to also understand why some people turn to myeloma and some people don't. What causes myeloma is difficult to narrow down in terms of what we can do for the myeloma. There's a lot of different treatments that can keep the myeloma under control for a long period of time. We can't quite say that we can cure the myeloma, but we seem to be making steady progress for. We need to better understand how these processes work. We need to develop better drugs, and we need to absolutely develop better tools for tracking of the disease. I started treating patients quite a few years ago with myeloma at the time, the average survival was only 1 to 3 years, and I was advised by senior doctors and mentors that they should probably not focus on myeloma because it was really a disease. What has not been a lot of development, I thought that was a great opportunity and I'm very glad I took that path. It has been just amazing to see during the past few years how survival has improved. I think we are now at the point, but the average patient that is offered optimal therapy probably has an overall survival, I would guess, on average 10 to 20 years. And I also know that there are very many new drugs in development. So I think doing those coming 10, 20 years, that will be very many new drugs that will come to clinic. So I think that could be patients that could live with the disease and live a very, very long life and also with very good quality of life. It should be said that that could be rough spots because we don't have yet to cure. And that's what we need to focus on, trying to come up with that.