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The symptoms of this tumor are not typical. It usually starts with weakness, bone pain, mostly in the area of the spine. Sometimes the kidneys are also damaged. In Poland, it is diagnosed very late, although the basic examination detecting the threat is blood count. What should you know about myeloma?
Interview with prof. dr. hab. n. med. Krzysztof Jamroziak from the Department and Clinic of Hematology, Transplantology and Internal Diseases of the Medical University of Warsaw on the subject of multiple myeloma.
Journalists for Health Association: What is multiple myeloma?
Prof. dr. hab. Krzysztof Jamroziak, MD, PhD: It is a rare bone marrow cancer that is still incurable. Every year in Poland, about 2 thousand. people, and about 10 thousand live with him. patients. The name comes from plasmocytes, or bone marrow cells that produce immune antibodies. It is from these neoplastic cells that multiple myeloma arises.
What are the symptoms of myeloma?
Most often uncharacteristic. Belong to them: progressive weakness (caused by anemia) and bone pain, most often related to the lumbar region spine, but also the ribs and pelvis. Less frequently, symptoms of renal failure (e.g. generalized edema) or elevated calcium levels are found at the diagnosis of the disease.
Further part under the video.
Who is most often affected by this disease?
Mainly the elderly – the mean age of onset is 70 years of age. Patients under the age of 40 constitute no more than 5 percent. patients. And because the symptoms mentioned above (weakness, backache) are quite common among people aged 70+, myeloma is diagnosed late, even several years after its onset.
Are women or men sick more often?
Men get sick 1,5–2 times more often than women. However, because statistically men live shorter lives and in the groups of 70- and 80-year-olds women are the majority, in total there are also more women among the sick in Poland. All ethnic groups are affected, most often the black race and least often Asians. In Poland, the incidence is similar to that in other European countries.
- Doctors call it a disease of welfare. “The patient blamed the sedentary work and it was cancer”
How is myeloma diagnosed?
The basis for suspecting myeloma are annual routine blood tests – especially blood counts, in which anemia is found, and basic biochemical tests with the assessment of kidney function. On the other hand, troublesome, especially occurring suddenly and lasting for several weeks, bone pain should be diagnosed as soon as possible by means of imaging tests (X-ray, computed tomography, magnetic resonance imaging). It should be noted that it is about bone pain, most often in the spine in the lower back, and not about joint pain. Pain in the knee or hip joints is the most common symptom of a degenerative disease. Deviations in these routine tests, such as anemia, may of course be due to many other diseases, but always require explanation.
- Buy Anemia Diagnostics Package – Anemia Testing Package. Thanks to the tests, it is possible to check whether the body has developed anemia
Are all tests for myeloma routine?
Not all. The myeloma cancer cells produce an abnormal protein called a monoclonal protein, which is a characteristic feature. In most patients, they can be detected in the blood or urine. The examination for protein evaluation (proteinogram) is ordered by your doctor. When we make a proteinogram on our own, we must remember that the detection of a monoclonal protein does not automatically mean myeloma. Much more common is a benign growth of plasmocytes called monoclonal gammapathy.
What is monoclonal gammapathy?
It is the presence of an abnormal protein produced by one group of cancerous or precancerous cells. If it appears, diagnosis for myeloma should be performed. If we exclude symptoms such as anemia, bone changes, kidney failure, elevated calcium levels, then we recognize monoclonal gammapathy (probably several hundred thousand people in Poland have it). It is a pre-myeloma condition which, however, only causes disease in a small proportion of patients. It does not require treatment, but requires regular observation by a hematologist or family doctor. Most people with monolonal gammapathy will never develop myeloma. The risk of this happening is 1%. per year.
- These symptoms could be signs of colon cancer developing
How is multiple myeloma treated?
Chemotherapy, including high-dose chemotherapy together with bone marrow transplantation, and recently more and more often also immunotherapy, which uses, among others, monoclonal antibodies. Probably the largest number of new drugs among all cancers has been approved for the treatment of myeloma in recent years.
The course of the disease is a cycle of relapses and remissions. If the disease returns quickly, i.e. within a few months after the end of treatment with a specific regimen (line of treatment), or progresses during treatment, the patient is considered to be refractory to the drug. Then drugs from a different group or drugs from the same group, but stronger, should be used. Some patients may receive up to a dozen different drug regimens.
What is the access of Polish patients to the myeloma drug program?
The March reimbursement list is a fulfillment of the long-term expectations of patients with multiple myeloma who have just received access to treatment: oral lenalidomide in the 1st line in both combinations – with dexamethasone (Rd) and with bortezomib and dexamethasone (RVd), as well as oral pomalidomide in combination with bortezomib and dexamethasone (PVd) in lines 2, 3 and 4. The March list also included daratumumab in the subcutaneous form, thus making patients independent of the need for long infusions and hospitalization. The introduction of these four drugs increases the possibility of personalizing the treatment of patients with multiple myeloma, which is a very diverse disease. The situation of patients, mainly in the first line of treatment, improved significantly.
What is needed to improve the prognosis of patients after 4th line of treatment?
We need, among others access to triple drug therapies that could overcome resistance to previously used drugs in most patients. This therapy consists of the so-called an immunomodulating drug or a proteasome inhibitor, a steroid drug, and a monoclonal antibody. An effective drug from the group of monoclonal antibodies is daratumumab, but we most often use it earlier than in the 4th or 5th line of treatment. Therefore, it is worth thinking about other medications. One of them is isatuximab. Drugs from this group of antibodies not only destroy cancer cells, but also activate immune mechanisms and inhibit cancer-promoting cells. Although daratumumab and isatuximab target the same target in the myeloma cell, we have reason to believe that isatuximab may work in some daratumumab-refractory patients, especially when used in the appropriate triplet therapy. The results of serious clinical trials indicate that such triple-drug therapy with isatuximab may be very promising for refractory patients for whom there is currently no effective treatment in Poland.
Is there any hope for reimbursement of the next treatment regimens?
I am convinced that new drugs will appear, also available for Polish refractory patients after the 4th line of treatment. I am thinking here first of all about regimens containing stronger drugs from the group of immunomodulating drugs and proteasome inhibitors combined with monoclonal antibodies. These drugs also contribute to extending the time to relapse and extending the life of patients who are resistant to treatments reimbursed in Poland today. In the future, there will also be a need for reimbursement of new immunological methods, such as immunotoxins already approved for the treatment of myeloma and genetically modified T lymphocytes (CART).
How many years can a patient with well-treated myeloma live in Poland?
Even 20-25 years ago, the average life span of a patient with myeloma was 2-3 years. Currently, with access to all therapies, it would be an average of around 6 years for the entire patient population. On the other hand, in the group under 70 years of age in patients undergoing transplantation – often for more than 10 years. It must be remembered, however, that in 20-25 percent. even the use of the most modern drugs brings less benefit to patients.
In the remaining 75 percent. the results have improved a lot: the lives of patients have been extended 20-2 times in the last 3 years. A large proportion of patients may be asymptomatic for years, and sometimes decades. Modern drugs give hope that the next therapies will be aimed at curing at least some of the patients in the near future.
Authorized press interview prepared by the Journalists for Health Association in connection with a lecture by prof. Krzysztof Jamroziak on September 25.09.2021, 19, during the XX National Conference “Polish Woman in Europe”, organized under the slogan Not only COVID-2021! Medicine in the era of the coronavirus pandemic. November XNUMX.
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