Myeloma is no longer the point of no return

Miot myeloma conclave 2019

Myeloma is no longer  the point of no return

It is an enlightening paper that focuses on developments that have been breaking new ground over the last 5 years when it comes to treating myeloma, which is a blood cancer arising from plasma cells.

There was a time when the condition used to be rarely diagnosed in India, mainly due to lack of awareness in the medical fraternity. Few orthopaedic specialists and nephrologists would have picked up myeloma in their patients. Although there is an increase in the number of myeloma cases being presented to Haematology / Bone Marrow Transplant (BMT) units today, there is still the urgent need to spread awareness on a larger scale.

As members of the press who have the power to reach out to larger communities and cities, your participation in this will do our society a world of good. For it is not only the physicians who must benefit from such an eye-opening conclave, but the general public as well.

What is myeloma?

Myeloma is a type of blood cancer that develops in the bone marrow. The bone marrow is home to various type of cells like red blood cells, neutrophils, lymphocytes, plasma cells and platelets. Plasma cells are a type of white blood cells that help antibodies fight infections. When their natural way of functioning gets affected, there will be an unregulated production of plasma cells. A cancerous plasma cell is called a myeloma cell. Myeloma is also referred to as “multiple myeloma” because there are frequently multiple patches or areas in bone where it grows.

Stats that matter

Myeloma is the 2nd most common blood cancer in the world. Men are 1.5 times more likely than women to develop multiple myeloma. While the disease is most frequently diagnosed in 65-74-year-olds, it is not uncommon among younger people  these days. Overall, two patients for every 150,000 turn up with myeloma. It adds up to 20,000 new myeloma cases every year in India.

How it affects the body

The composition of plasma cells is around 5% in the bone marrow. If cancer occurs in these plasma cells, they will start increasing in the bone marrow and once they reach a critical threshold, they will start occupying more space in bone marrow and prevent the growth of normal cells resulting in low blood counts. 

To make space for itself in bone marrow, they erode bone and make space for themselves. This will release calcium from bones and make calcium levels in blood to go high sometimes causing life threatening complications like seizures. Due to bone erosion, patient starts having severe back pain and frequently get bone fractures even after a trivial injury. Normal plasma cells secrete globulin to provide immunity. As plasma cells multiply, the globulin level in the blood increases. When it gets deposited in the kidney, there is a chance of kidney failure. 

Myeloma symptoms

  • Long standing low back pain in a patient above 50 years of age
  • Low blood count (especially anemia) which makes the patient unresponsive to supplements or balanced diet
  • Repeated chest infections more than two times within three months or more than six times in the last year
  • Weakness of lower limbs and poor control of bladder / bowel with back pain

Widely used treatment procedure – chemotherapy

Myeloma treatment generally depends on the stage of the cancer. For patients with multiple myeloma, chemotherapy is typically given orally (by mouth, in pill form) or intravenously (by injection into the vein), which comprises of a single or a combination of drugs. Conventionally, six to eight cycles of chemotherapy is administered followed by oral maintenance.

The drawbacks of chemotherapy

  • Chemotherapy affects the bone marrow’s ability to produce adequate numbers of blood cells. As a result, the blood count (the number of white cells, platelets and red cells circulating in your blood) will generally fall within a week of treatment. When the platelet count is extremely low, the patient can bruise and bleed more easily
  • If the red blood cell count and haemoglobin levels drop, the patient will probably become anaemic (condition where there aren’t enough healthy red blood cells to carry adequate oxygen to the body’s tissues)
  • Though chemotherapy will achieve initial control, the chances of the disease recurring early within the first three years is very high

Change in treatment paradigm

There have been major advances in the last 5 years in the diagnosis and treatment of myeloma. The internationally-accepted standard of treatment when it comes to myeloma patients is to give:

  • Three to four cycles of novel agent combination therapy
  • Followed by Bone Marrow Transplant
  • And oral drugs for maintenance post-discharge

There are novel agents which are independent of chemotherapy, making the treatment of this disease very effective, thereby increasing the life expectancy to many more years than standard chemotherapy alone. Though these drugs give us a deeper understanding of treating myeloma and a control over the disease, curing myeloma fully is rare. 

Treatment at miot

While many hospitals resort to 6-8 cycles of chemotherapy as a treatment method for myeloma, MIOT is one of the few Bone Marrow Transplant centres in the country equipped to follow the internationally-accepted standard of treatment for myeloma. 

By doing this we are be able to reduce inpatient admissions to a period of maximum three months. Then patient is managed with oral drugs and OP based follow up. This method gives a deep and continued remission of myeloma for atleast 5 to 8 years. We published our results in European Hematology Journal.

Myeloma protocol at miot

Our protocol in patients up to 70 years of age:

  • Give three to four cycles of novel agent chemotherapy, once they achieve a good response do an early bone marrow transplant
  • By doing this we can reduce the actual frequent hospitalization to less than 3 months and manage patient more as OP
  • We have got deeper responses by doing this and >80% of our patients are disease free over last 5 years only on oral maintenance drugs like for diabetes
  • We have successfully completed 105 myeloma transplants in last 5 years.
  • Our oldest Myeloma transplant was 72 years when done and he is still free of disease at 79
  • We have reduced cost of transplant to around 20 times cheaper when compared to western countries with a comparable outcome
  • Being a multispecialty hospital, it’s easier for us to collaborate with multiple departments for faster diagnosis and early treatment before the condition progresses
  • Newer therapies like CAR-T cell are in the pipeline for patients with refractory disease

MIOT Institute of Haematology, Haemato-oncology and Bone Marrow Transplant

MIOT International caters to the specialised haematological needs in all specialities under one roof through the MIOT Institute of Haematology, Haemato-oncology and Bone Marrow Transplant. Over the years MIOT has developed as a centre of excellence in Leukemia, Myeloma and Lymphoma treating all types of complex and relapsed cases. The centre’s comprehensive, state-of-the-art facility is easily the most advanced in the country and is headed by an expert team of highly qualified specialists who have worked in some of the best medical centres across the world.

Milestones

  • One of the earliest centres in the country to do T- Replete Haplo – Identical Bone Marrow Transplant
  • First and one of the biggest centre in Tamil Nadu to have a valid bone marrow transplant license
  • MIOT has in-house Flow Cytometry, stem cell processing and Cryopreservation facility
  • The centre has done transplants in nearly all transplantable haematological conditions like Leukaemia, Myeloma, Lymphoma, Thalassemia and Sickle cell anaemia
  • Haemato-Oncology & Bone Marrow Transplant Centre has completed more than 312 Bone Marrow Transplants since 2013 with a success rate on par with the best centres in the world.  

The author is Senior Consultant Haemato -Oncologist and Bone marrow Transplant Physician at MIOT International Hospital, Chennai

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