March is Myeloma Awareness Month


March is the official Myeloma Awareness Month this year. Below are some facts on Multiple Myeloma courtesy of the International Myeloma Foundation.

  • Multiple myeloma is a cancer of the plasma cell in the bone marrow.
  • At diagnosis, approximately 80% of multiple myeloma patients have bone involvement; approx. one half have bone pain and 30% have collapsed vertebrae.
  • Survival statistics for myeloma patients have doubled in the last decade.
  • 20,000 new cases of multiple myeloma were diagnosed in the United States in 2011/2012; the global estimate of people living with myeloma is 750,000.
  • MGUS precedes myeloma in virtually ALL cases, however NOT all MGUS becomes myeloma.
  • Low-risk patients never get myeloma; high-risk patients get myeloma within two years.
  • Myeloma in 2012 is a treatable disease. 95% of patients respond to novel agent/combo RX. Long term remissions (> 5 years) occur, but cure remains elusive.
  • CRAB features identify patients with active myeloma requiring RX.
  • Multiple myeloma occurs more commonly in men and in some racial groups, such as African-Americans.
  • Abnormal plasma cells producing monoclonal protein (a single type of non-functional immunoglobulin) replace normal plasma cells producing functional antibodies required to fight infection. The result is hypo gamma globulinemia of normal immunoglobulins.
  • Bence Jones protein is a light chain protein produced by myeloma cells and excreted into the urine. This is a key indicator of the light chain type of myeloma.
  • Bone marrow biopsy can be used to determine the disease status of myeloma by showing the percent of abnormal plasma cells (myeloma cells). 0% confirms bone marrow complete response (CR).
  • Immunofixation (IFE) is used to determine if a monoclonal protein is present and the heavy and/or light chain type of the protein (IgGκ= G heavy chain/ kappa light chain).
  • The serum-free light chain assay (sFLC) is a very sensitive test to measure light chains not bound to heavy chains. Light chain results can occur even when SPEP (serum protein electrophoresis) is negative.
  • SFLC (Serum Free Light Chains) can be used to assess disease status in approximately 70% of patients with non-secretory myeloma in whom SPEP and UPEP are both negative.
  • The International Staging System (ISS) can be used to give an idea of the prognosis of a patient’s multiple myeloma.
  • X-rays remain the standard of care in the initial assessment of potential myeloma bone disease. However, other imaging (MRI &/or PET/CT) may be necessary to fully clarify bone issues.
  • Protein electrophoresis of serum and urine is the key test for monitoring monoclonal protein levels in patients with myeloma.
  • Bisphosphonates are drugs that bind to the surface of the bone and protect against osteoclast activity.
  • As of 2011, the novel agents used to treat myeloma are Thalomid, VELCADE®, and Revlimid®. New agents expected to get approval in 2012 are pomalidomide and carfilzomib.
  • There is only a weak family tendency to develop multiple myeloma in approximately 3-5% of patients.
  • Nonsecretory multiple myeloma is characterized by the absence of a monoclonal protein in both the serum and urine.
  • Autologous stem cell transplant is a standard treatment option for younger myeloma patients.
  • Patients who are receiving therapy that includes VELCADE® and dexamethasone in combination with other drugs should be taking an antiviral.
  • If on VELCADE®, patients should avoid taking alpha-lipoic acid, acetyl l-carnitine and Vitamin C on the days they receive the drug.
  • Peripheral neuropathy can be treatment related and/or disease related.
  • Factors associated with triggering multiple myeloma include: environmental toxins, certain types of viruses, and autoimmune diseases.
  • A myeloma patient taking steroids should have bone density checked and restart and/or continue bisphosphonates if needed.

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