An NCI-designated Comprehensive Cancer Center
By Kevin Chesley | March 30, 2018
Upadhyaya-Gargi Gargi Upadhyaya, M.D.

Multiple myeloma is a blood cancer involving malignant white blood (plasma) cells in the bone marrow. Most often affecting patients 65 and older, it is a debilitating malignancy.

Gargi Upadhyaya, M.D., an assistant clinical professor specializing in hematology and medical oncology at City of Hope, is leading the fight against it.

Symptoms, Signs and Risk Factors

There are no genetic components to multiple myeloma, so doctors need to read the indicators that a patient may be at risk. “A primary care physician should look to see if a patient has lost more than 10 percent of their body weight, or has a hemoglobin count of less than 10 grams, a decreasing white blood cell count or night sweats — all of these are common symptoms,” Upadhyaya said.

Recurrent infections are also a sign. “One month they have an upper respiratory infection, the next month a sinus infection, the third month a urinary tract infection … something’s going on. We need to send this patient to a specialist,” Upadhyaya added.

Next steps would be to check kidney function and determine if the subject’s white blood cell count is abnormally low. A serum protein electrophoresis is ordered to measure the patient’s immunoglobulin levels.

“There are five kinds of immunoglobulin, but we pay attention mainly to the G, A and M parts,” Upadhyaya explained. “If one is very high and the others low — or if we see an abnormal band of protein on the electrophoresis — it increases the suspicion of multiple myeloma.”

Once a diagnosis of multiple myeloma is established, further testing is done to determine the disease’s severity, including a bone marrow biopsy, genetic tests for CD38 and p53 mutations and the deletion of certain chromosomes, as well as X-rays of the entire body.
“Multiple myeloma may cause pathological lytic [bone] fractures. If the patients have that, it confirms the diagnosis. We don’t need to biopsy the bone, the blood picture and X-rays give confirmation and an indication of whether to treat a patient aggressively, or with standard treatments versus a [bone marrow] transplant.”

Treatable But Not Curable

Although multiple myeloma is currently incurable, its treatment is not very aggressive. A medication is injected under the skin twice a week for two weeks. After that, a week is given off of the medication before the process is repeated four times, followed by a bone marrow biopsy. Another medication is given once a month to strengthen the bones if there are lesions detected.

Age of Remission and Transplant

Seventy is the cutoff age for bone marrow transplants. If a patient is older than 70, they are put on a maintenance therapy of two separate medications. “If they are younger and they’ve gone into complete remission — the bone marrow has less than 5 percent of the myeloma cells — then we send them for evaluation for a bone marrow transplant.”

The transplant doesn’t involve the removal of the marrow or borrowing it from someone else. “It is taking the stem cells from the patient, freezing them, giving them more extensive chemotherapy and reinfusing them to grow in a person’s body. This is called an autologous transplant, and it makes the chances of survival much higher, with fewer side effects. Patients can stay in remission for more than 10 years.”

Upadhyaya is also involved in clinical trials seeking targeted therapies with fewer side effects and treatments that are better than the current standard. “Unofficially, I can say we have seen a lot of people living longer, but the trials have not been published yet. I tell my patients to keep moving. The more you move, the more the myeloma will not catch up with you. It is a treatable disease. You live a long, normal life, especially if you exercise and keep moving.”

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