Multiple myeloma is a blood cancer attacking the bones in the human body. A disease of people over the age of 50, myeloma predominately affects people in their 60s and there is a slight male predominance. Currently there is no cure, although some effective medications are available to treat the disease initially.
“This is a very debilitating disease if it’s left untreated,” says G. David Roodman, MD, PhD. Roodman is director of the Multiple Myeloma Center at the University of Pittsburgh Cancer Institute, he is director of the Center for Bone Biology at UP Medical Center, and he is also a professor of medicine in the Division of Hematology and Oncology at the UP School of Medicine.
Symptoms
Roodman says that about 60 percent of patients present the disease with bone pain and about 85 percent to 95 percent of these people will develop bone destruction, bone pain, and fractures without any kind of injury to cause the fracture. “We do have treatments that can control the disease for quite some time – but unfortunately patients eventually will relapse with their disease,” Roodman says.
In addition to bone pain, symptoms can also include lethargy, anemia, kidney problems or symptoms of high blood levels of calcium. “So they might feel tired, constipated or confused – but most of the time they present with being tired or having bone pain,” explains Roodman, adding pain can be where the myeloma is involved – or it can be spotty or involve the entire skeleton. Common symptoms of kidney problems can include back or rib pain.
“People usually present with bone pain and their doctor will do initial screen-testing to see that their blood counts, protein levels and electrolytes are normal,” Roodman says. “If the disease is present there is usually an elevated protein level or problems with the kidneys. In that case, the doctor will run a special test called a serum protein electrophoresis to see if there is a monoclonal protein present.”
An examination of both the serum and urine can best detect the presence of a monoclonal protein, which will drive further diagnostic work. “The important thing to remember is there are lots of people with monoclonal proteins that don’t have myeloma,” advises Roodman. “Having a monoclonal protein doesn’t mean you have myeloma – it just suggests you need further evaluation and if you have the symptoms in addition to the protein, then it’s even more imperative to get evaluated.”
No risk factors have been clearly identified and there are no familial tendencies for the disease. “It doesn’t appear to be hereditary and there is no evidence of industrial exposure clearly liked to the development of myeloma,” Roodman says.
Available Treatments
A lot more progress has been made recently in understanding the molecular basis of the disease than there had been just 10 years ago. Some effective medications are available to treat the disease initially and stem cell transplantation is also effective in a significant number of patients, reports Roodman. “There are also several new agents soon to be approved by the FDA to treat myeloma – so it’s a much more encouraging situation that it was 10 years ago,” he continues. “There are about 40 agents being evaluated both at the pre-clinical and at the clinical trials level to treat myeloma. These drug treatments are based on what’s known about the molecular biology of the disease and researchers are identifying very good targets now to treat patients.”
Although there are patients who, after stem cell transplants and other therapies, live as long as 12 to 14 years, the median life expectancy is about four years after the disease has been identified.
Myeloma is caused by a transformed plasma cell, which is a cell that normally produces antibodies to help us fight off infections, explains Roodman. “Except what happens in this case is one of these cells becomes transformed and starts replicating itself multiple times – so it becomes a clone of cells and this is a clonal disease. Most of these cells make a useless antibody which allows doctors to track the disease by examining blood levels and looking for a myeloma protein or a monoclonal protein.”
Progress is continuing in better understanding the molecular basis of the disease. But what causes those cellular transformations is unclear. “Whether it’s just spontaneous or whether it’s two different events where you have a genetic predisposition and then you have another event that makes you develop the disease is still unclear,” Roodman explains.
Current oncology treatment focuses on individualized therapy to the patient, depending on the biologics of their disease, notes Roodman. “The type of drugs used to treat myeloma can vary according to whether a patient has been newly diagnosed, or has been treated and then has had a recurrence of myeloma,” he explains. “Treatments also consider whether or not a patient shows good or poor prognostic features and they are also based on a study of the patient’s myeloma cells. There is a greater understanding today of the biology of the disease so the medical community can tailor treatments for patients within the different prognostic groups.”
Myeloma was first described over 100 years ago. Roodman says statistics show there were about 14,000 cases of myeloma reported in 2002 in the US and today that number is up to about 16,000 new cases annually. “That could be due to the fact that the population is aging and it’s a disease of people 60 or older,” he explains. “There is also better awareness on the part of physicians to diagnose the disease much earlier than years before.”
About 50,000 patients at any one time have the disease in the US. “This is the second-most hematological malignancy and it occurs about twice as frequently in African Americans,” Roodman reports. The incidence is about 10 per 100,000 in African Americans and about five per 100,000 in Caucasians. The incidences increase in both groups as they age.
Dr. Roodman came to UPMC about five years ago from the University of Texas, where he worked for 21 years. He had also established a myeloma program there five years prior to coming to Pittsburgh. “Part of the reason for coming to the University of Pittsburgh was to set up a myeloma program and to develop a bone biology center,” he says.