Home » Publications » Health Sciences » Winter 2011 » Clinical Care
The author's mother, Bev Tricoles
To this day, the words multiple myeloma make my heart skip.
They take me back to memories of my mother’s premature death from this disease, a tenacious cancer of the plasma cells. Little was known about multiple myeloma in the early 1970s when my mother was diagnosed at age 42. Although she had little hope of living long with the disease, thankfully, times have changed, and things have improved for those who have multiple myeloma today.
One of the most famous people to benefit from knowledge about the disease garnered over the past 40 years is Geraldine Ferraro. The first female vice presidential candidate on a major party ticket, Ferraro was diagnosed with multiple myeloma in late 1998. Now, at 75, she is still living with this cancer, which her physicians are able to treat like a chronic disease. She has access to an array of therapies and a clinical trial.
Clinical trials are one of the most effective ways to treat multiple myeloma, according to Emory oncologist Sagar Lonial at the Winship Cancer Institute. “Although the prognosis for people with this cancer is poor, progress is being made,” he says. “Twenty years ago, the survival rate was two to three years. Now it’s four to five. One of the keys to some patients’ longevity is increasing enrollment in clinical trials and access to life-extending drugs.”
Estimates put the number of people in the United States who are living with multiple myeloma in the tens of thousands. Healthy plasma cells that live in the bone marrow make antibodies that protect us from antigens like bacteria and viruses. But if those plasma cells become unhealthy—that is, if they grow unchecked—the unchecked growth leads to multiple myeloma.
This type of cancer results in lytic bone disease, or holes in the bones. What’s more, the malignant cells crowd out normal bone marrow, resulting in anemia or a low white count and leaving a person vulnerable to infections.
Multiple myeloma is most commonly seen in men, people older than 50, and African Americans. The average age of patients at diagnosis is 65. However, Lonial also treats many young patients with the disease, one as young as 25 and a lot in their 40s. One Emory researcher has shown that the average age of African Americans at diagnosis is lower than that in other races.
Lonial’s research focuses on combining new drugs, which are administered in a highly regimented order. “The sequence of administration may be very important because you may block the effect of a second drug if the first drug is given out of order,” Lonial says.
Currently, he and his colleagues at Emory’s Winship Cancer Institute are conducting a national epidemiologic study that collects blood samples from more than 1,000 African Americans with multiple myeloma. The researchers will use those samples to sequence the genome to see if they can identify genes that are associated with a higher risk of multiple myeloma in African Americans.
Meanwhile, with drug order in mind, researchers also are interested in identifying new targets in myeloma—targets that may not be broadly represented in all patients. “We have to get away from the idea that myeloma is a single disease,” says Lonial. “It’s not. There are probably about seven or eight genetic subsets of myeloma. What I think we’ve seen throughout oncology is a revolution on both sides of the equation. We now understand the specifics of cancer better, and we have more tools with which to attack this cancer.” —Robin Tricoles
FAQs
Since bone marrow failure affects the healthy blood cell production, patients with bone marrow failure often experience:
- Fatigue.
- Shortness of breath.
- Pale appearance.
- Frequent infections.
- Easy bruising or bleeding.
- Bone pain.
Bone marrow failure (BMF) refers to the decreased production of one or more major hematopoietic lineages, which leads to diminished or absent hematopoietic precursors in the bone marrow and attendant cytopenias. It can be divided into two categories: acquired and inherited.
What is the most common bone marrow disease? ›
Fanconi anemia is the most common type of inherited bone marrow failure disorder. It affects from 1 to 5 out of every 1 million people.
What blood tests show bone marrow problems? ›
The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If there are too many myeloma cells in the bone marrow, some of these blood cell levels can be low. The most common finding is a low red blood cell count (anemia).
What is the life expectancy of someone with bone marrow failure? ›
With current treatments, patients with lower-risk types of some MDS can live for 5 years or even longer. Patients with higher-risk MDS that becomes acute myeloid leukemia (AML) are likely to have a shorter life span.
How do you fix bone marrow problems? ›
A stem cell transplant, also called a bone marrow transplant, is generally the treatment of choice for people who are younger and have a matching donor — most often a sibling. If a donor is found, your diseased bone marrow is first depleted with radiation or chemotherapy.
Can you reverse bone marrow failure? ›
Bone marrow failure can also be treated with stem cell transplant. Otherwise known as a bone marrow transplant, a stem cell transplant involves is the infusion of healthy blood stem cells into the body to stimulate new bone marrow growth and restore production of healthy blood cells.
Is bone marrow failure reversible? ›
Myelosuppression is usually reversible; however, it may take several months for the white blood cell count to return to the normal range, and some patients remain relatively leukopenic. Irreversible, fatal bone marrow suppression has been reported in patients receiving chlorambucil for rheumatic disease.
What destroys bone marrow? ›
As a result, the bone marrow makes fewer red blood cells , white blood cells , and platelet . The most common cause of bone marrow damage is from your immune system attacking and destroying the stem cells in your bone marrow. This is a type of autoimmune illness, a disease that makes your body attack itself.
Which drug causes bone marrow failure? ›
Several chemotherapies may cause myelosuppression, but the most common include: Fluorouracil. Oxaliplatin. Irinotecan.
Viral infections that affect bone marrow can play a role in the development of aplastic anemia. Viruses that have been linked to aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV. Pregnancy. Your immune system might attack your bone marrow during pregnancy.
What does bone marrow disease feel like? ›
a persistent bone pain, usually in the back, ribs or hips. tiredness, weakness and shortness of breath – caused by anaemia. high levels of calcium in the blood (hypercalcaemia) – which may cause symptoms including extreme thirst, stomach pain, needing to pee frequently, constipation or confusion. weight loss.
How do you know if your bone marrow is failing? ›
In most cases, bone marrow failure is suspected when your child has an abnormal blood count taken during a blood test. The blood test will show a decrease in hemoglobin, white blood cell count and platelets – sometimes only one cell line is initially affected. The red cells are also usually large in size.
What organ is most affected by multiple myeloma? ›
Progressive skeletal destruction is the hallmark of MM and responsible for principle morbidity in the disease. The spine is the most afflicted skeletal organ, and vertebral fractures have significantly contributed to its poor prognosis.
Why would a hematologist order a bone marrow test? ›
Your doctor may order a bone marrow exam if blood tests are abnormal or don't provide enough information about a suspected problem. Your doctor may perform a bone marrow exam to: Diagnose a disease or condition involving the bone marrow or blood cells. Determine the stage or progression of a disease.
Can bone marrow problems be cured? ›
Stem-cell transplant is the only possible cure for aplastic anemia. Talk with your health care professional about the risk and benefits of a stem-cell transplant and if the procedure is right for you. Are you or someone you know considering becoming a bone marrow or blood stem-cell donor?
How does bone marrow pain feel? ›
Bone pain can occur in leukemia patients when the bone marrow expands from the accumulation of abnormal white blood cells and may manifest as a sharp pain or a dull pain, depending on the location. The long bones of the legs and arms are the most common location to experience this pain.
What are the symptoms of bone marrow inflammation? ›
The main symptom of bone marrow edema is pain around or in your bone. Other symptoms may include: Joint effusion (swollen joints). Warm joints.
