Previously, on the Onco.com Paathshaala Sessions, we spoke about Cancers of the Sacrum, including Multiple Myeloma and Ewing’s Sarcoma.

Following up on that discussion, Team Onco.com is pleased to present an exclusive interview with expert oncologist Dr Dhaval Shah, who shares definitive answers about Multiple Myeloma, a disease that he specializes in.

Q&A on Multiple Myeloma with Dr Dhaval Shah

What is Multiple Myeloma?

Multiple Myeloma is a bone marrow/blood disorder of plasma cells. Plasma cells are a type of mature immune cells which produce various antibodies to fight different infections. In multiple myeloma, these plasma cells become cancerous, leading to an abnormally increased production of antibodies, which are responsible for tissue damage.

What are the Symptoms of Multiple Myeloma?

Patients with multiple myeloma can present with various symptoms such as fatigue, weight loss, constipation, decreased urine output and kidney failure, back pain, and a general state of confusion.

These symptoms are related to any one of the “CRAB” criteria used in diagnosis of myeloma. CRAB stands for hyperCalcemia (high calcium), Renal (kidney) failure, Anemia (low hemoglobin), or Bone damage (bone lesions or Osteoporosis).

How is Multiple Myeloma diagnosed?

Classically, multiple myeloma is diagnosed when any of the four “CRAB” criteria are present along with abnormal blood protein results, and abnormal bone marrow biopsy results.

Various tests are used to establish a confirmed diagnosis, including:

• Blood Protein Electrophoresis
• Urine Protein Electrophoresis
• Bone X-rays
• Bone Marrow Biopsy
• Routine Blood Work (Such as CBC – Complete Blood Count and Chemistry Panel)

How is Multiple Myeloma staged?

Multiple myeloma is staged into three stages. The staging depends on the detected levels of two proteins in the blood – Albumin and Beta-2 Microglobulin. Patients with Stage-III Multiple Myeloma have worse outcomes as compared to those afflicted with a Stage-I disease. But more important than staging, various chromosome tests during Bone Marrow Examinations, are important from the perspective of treatment and prognosis.

How is Multiple Myeloma treated ?

Generally as a first step in treatment, the most important thing to determine is whether a patient is a Bone Marrow Transplant candidate. Eligibility for Bone Marrow Transplants is dependent on various factors, such as age, medical comorbidities and the functional status of the patient. The typical age cut off for transplants is 65 years of age. However, with patients living longer healthier lives and with improvements in supportive care, more patients aged more than 65 years of age are also undergoing Stem Cell Transplants.

Once a decision regarding transplant eligibility is made, the initial treatment is usually a combination of 2 or 3 drugs. The three most commonly used drugs are Bortezomib, Lenalidomide and Dexamethasone. After 3 to 4 months of initial induction treatment, if there is good response to treatment, then a Stem Cell Transplant can be considered.

Stem Cell Transplants in multiple myeloma are autologous types of transplants. In an autologous transplant, the patient’s own stem cells are infused back after giving a high dose of chemotherapy. Following the Stem Cell Transplant, generally patients are given maintenance treatment with either Lenalidomide or Bortezomib.

In patients who are not eligible for transplant, generally initial treatment is with the above listed 2 or 3 drugs for 3-4 months followed by maintenance treatment.

In the past few years, new antibodies such as Daratumumab and Elotuzumab have been approved for the treatment of relapsed Myeloma. These antibodies are showing extremely good results in patients with relapsed disease, and are generally combined with another 1 to 2 drugs.

“Multiple myeloma is not considered a curable disease. However, given rapid treatment advances and approval of several drugs over the past 10 years, patients with multiple myeloma can live for many years with this disease.”
– Dr Dhaval Shah

Further Reading : Extremely Optimistic About The Future Of Oncology, Says Dr Dhaval Shah

^{About the author: Dr Dhaval Shah is a board certified expert in both hematology and medical oncology, who works at an NCI-designated Community Cancer Center. His journey of learning and practicing medicine is both awe-inspiring and eventful. After finishing medical school at Sion Hospital in Mumbai, Dr Shah moved to the US to further hone his skillset. Presently, he specializes in cases of benign and malignant hematological disorders, and all aspects of medical oncology.}

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