Wednesday 24th June 2015
Mac Voice, the magazine for Macmillan professionals: Summer 2015
Jamie Doolan describes the advances that have been made in understanding and treating this haematological cancer type
Working as a Macmillan myeloma clinical nurse specialist (CNS), I often find myself explaining to people with cancer and their carers: ‘it’s myeloma, not melanoma’. Many have never heard of myeloma. And yet after non-Hodgkin lymphoma, myeloma is the second most common haematological malignancy. In the UK, an estimated 4,792 people were diagnosed with myeloma in 2011, while in 2012 there were 2,742 deaths from myeloma.
During the past decade, several novel treatments have extended the average survival time for people with myeloma, from less than three years to more than seven years.
Myeloma accounts for 10% of all haematological malignancies . It’s caused by malignant plasma cells, which increase in size and produce high amounts of a special protein. These proteins are referred to as monoclonal paraproteins (M-protein). Myeloma plasma cells reproduce and lead to ‘B-symptoms’ such as night sweats, an impaired immune system, lytic bone lesions and pain from skeletal involvement.
What causes plasma cells to become malignant in myeloma is unknown at the present time. The myeloma cells multiply and suppress the normal plasma cells, meaning large amounts of abnormal protein are produced.
Staging of myeloma
A lot of patients ask about staging of myeloma, which is based on two specific proteins in the blood, called albumin and beta 2 microglobulin (B2m).
The stages are:
- smouldering: myeloma with no symptoms
- stage I: early disease with no symptoms (albumin and B2m levels normal)
- stage II: multiple symptoms and more advanced disease (albumin is low or B2m slightly raised)
- stage III: multiple areas with myeloma cells and complex symptoms (B2m level higher than normal).
Making treatment progress
Myeloma was first diagnosed more than a century ago, but until fifty years ago, there were no known treatments. People with symptomatic disease develop fractures, severe bone pain, fatigue, infection and hypercalcemia. If untreated, people typically live less than one year.
The first breakthrough in treating myeloma came in 1963 with the introduction of melphalan, a chemotherapy drug. Melphalan combined with prednisolone (a steroid) increased the median survival time from less than one year to approximately three years. However, it was not until the 1980s that further progress was made, when high-dose chemotherapy combined with peripheral blood stem cell transplantation was introduced.
Since the dawn of the new millennium, the advances in novel agent therapy have been breathtaking. From thalidomide to velcade, lenalidomide and now pomalidomide, vorinistat and carfilzomib, the new use of treatments for myeloma is giving real hope that this once incurable disease may become a chronic condition and that patients may have a better quality of life.
Important research into myeloma is being conducted in many university hospital medical centres and in various institutions around the globe.
Each year, scientists find out more about what causes the disease and how to improve treatment. For example, research has shown that bone marrow-support tissue and bone cells produce growth factors. These increase the growth of myeloma cells. In turn, myeloma cells produce substances that cause bone cells to undergo changes that weaken bones. Such discoveries are helping researchers develop treatments that block growth factors and reduce bone damage.3
With ongoing research and drug trials, doctors are constantly learning more about myeloma, ways to prevent it, and how to provide the best care to people diagnosed with the disease. The use of conventional agents, novel agents, combination therapies and stem cell transplantation is responsible for improved outcomes. There is huge optimism for future treatment in myeloma.
With more emphasis on cytogenetic profiling, these advances will hopefully further define people at highest risk for rapid progression of their disease.
Not only will this help to identify people who may benefit from the most aggressive intervention, but it may eventually lead to treatment regimes that are specifically tailored to the genetic profile of each individual’s myeloma.
Macmillan has a booklet aimed at people affected by cancer called Understanding myeloma. We also have a video about myeloma at macmillan.org.uk/cancerinformationvideos
1. Cancer Research UK. Myeloma statistics.
(accessed 14 May 2015).
2. Moreau P, San Miguel H et al. Multiple Myeloma: ESMO Clinical Practice Guidelines. Annals of Oncology. 24(6): 133–137.
3. American Cancer Society. Multiple myeloma. Fact sheet.
www.cancer.org/acs/groups/cid/documents/webcontent/003121-pdf.pdf (accessed 14 May 2015).
Macmillan Myeloma CNS
The Royal Liverpool Hospital