What is extra medullary disease?

How is it treated?

So extra medullary
disease is the kind of hot topic nowadays.

And basically medullary disease.

The medulla is inside the marrow.

Once the disease spreads outside the bone
marrow space,

we call that extra medullary.

And this is becoming more and more common

because we have such great drugs nowadays.

And basically if you take
your initial myeloma and treat it,

that 1% that survives is more resistant
then that grows up and you kill that.

And the 1% that survives grows up.

And ultimately you develop

this more resistant disease
that can live anywhere in the body.

Normally,
myeloma has to live inside the marrow.

It's like a plant.

It needs the roots,
the soil to survive.

But extra other diseases like a tree.

That said, I don't need the soil,
just got up and started walking away.

There's no specific therapy
for extra medullary disease.

Certain drugs
seem to have better efficacy than others,

but we don't really have it nailed down
exactly which combinations just yet.

And especially when you develop a lesion.

If it's in a really bad place.

We always have the ability to radiate.

extra medida
disease is when the myeloma cells

they go outside of the bone marrow
and they can form localized tumors

and different place of the body
outside of the bones are the bone marrow.

extra metal over this is can be seen in
any part of the body.

We can see it in lymph nodes.

We can see it in
different types of organs.

We can even see it in the skin.

It, unfortunately, can go into any tissue
or any organ in the body.

This can be treated normally.

We treat this in the same way
as multiple myeloma.

In general,

these tend to they can be
sometimes a little bit harder to treat,

and sometimes they require
more traditional chemo

to treat
that kind of an extra medullary disease.

If it's localized in one region
or one site, we can also,

if applicable,
we can also do radiation therapy.

So I start off by talking a little bit
about multiple myeloma and,

you know, a lot of folks
that that are new to understanding

what multiple myeloma is always wondering,
you know, what their stages if they have

metastatic disease, etc., etc..

And because those are the kind of common terms we hear for
for the more common cancers,

which are really the solid cancers
like breast cancer and and lung cancer.

But however, multiple myeloma
and it's very early steps

is already throughout your body
because it is a blood

cancer and blood travels
all over your body.

So as you know,
the plasma cells of the myeloma cells,

their natural residence is inside the bone
marrow.

And most patients, when we first diagnose
them, definitely in the earlier stages,

those cells are still confined.

You know, in the in the bone marrow.

So the bone marrow obviously, is that
space, you know, within within your bones.

So extra medullary disease is really
when the myeloma cells

really are able to break free
from the bone marrow

and are able to survive and actually
thrive outside of the bone marrow.

I think the state of the science right now
is the best use, the best drugs

for multiple myeloma that you have
for that patient at that moment.

It regardless of
whether they have extra medullary disease

or not, I think then, you know,
there's important questions.

For example,
you know, is it isolated extra medullary

lesion plasma, say, Tomei or something,
or is it really diffuse?

Is there a role for radiation?

Sometimes if they're little
or if they're causing, you know, pain and

other problems.

And also, lastly,

you know, to get a sample of that
and look at it under the microscope,

I think is really important
because sometimes you can actually see

morphologic changes in those myeloma cells
that may kind of suggest

that a certain type of regimen
may work better than the other.

Like, for example, sometimes what we see,
especially a particular type,

particular types of myeloma, is
the cells may actually

regress.

You know,

meaning
they may look like younger cells or cells

that are different
and and what we call medically anaplastic

or lymphoma plasma aplastic
and sometimes those type of,

you know, transformations patients may do,
you know, or the tumors may respond

better to more traditional
cytotoxic chemotherapies.

Even in myeloma, you know, therapies
that we use anyway, like,

you know, the regimen up, for example.