By Sue Rochman
Dear Ann Landers
New research has led to the approval of drugs that are helping patients live longer lives with multiple myeloma—a cancer that took the life of a beloved advice columnist less than a decade ago
By Sue Rochman
Landers was 83 when she was diagnosed with multiple myeloma in January 2002. Also known as plasma cell myeloma or Kahler’s disease, multiple myeloma is a type of cancer that begins in the bone marrow, the tissue inside the bone that produces blood. As the disease progresses, plasma cells—the white blood cells in the bone marrow that produce antibodies—become increasingly abnormal. This reduces blood production, leading to the cancer’s most common symptoms: anemia, fatigue, hypercalcemia (too much calcium in the blood) and kidney failure. Multiple myeloma also causes tumors to grow in the bone, resulting in intense bone pain that often accompanies the disease.
The NCI estimates that 20,180 people will be diagnosed with multiple myeloma in 2010, and that about 10,650 people will die of the disease. Multiple myeloma is more likely to occur among the elderly, with approximately two-thirds of patients being diagnosed over age 65.
Multiple myeloma can be diagnosed before symptoms develop through a blood test known as a complete blood count (CBC). But Landers, like many others, wasn’t diagnosed until after she went to her doctor complaining of pain. “Mother was having terrible back pain,” recalls Howard, “and she said, ‘I don’t care what it is—it’s either cancer of the spine or something else,’ ” and she avoided seeing a doctor for months. But then, “the pain got so unmanageable she decided that she needed to know what it was.”
A Smoldering Disease
Multiple myeloma virtually always begins as monoclonal gammopathy of undetermined significance (MGUS), a benign condition that is marked by the presence of an abnormal protein in the blood and diagnosed in about 3 percent of individuals over 50. If MGUS progresses, it becomes what is referred to as asymptomatic or smoldering multiple myeloma. At this stage the plasma cells have become malignant, but they are not life-threatening. The risk of progressing from MGUS to multiple myeloma is about 1 percent per year, while the risk of progression from smoldering multiple myeloma to symptomatic disease is between 10 and 20 percent per year. Individuals diagnosed with MGUS and smoldering disease are monitored closely. Treatment doesn’t begin until an official multiple myeloma diagnosis is made.
When Landers was diagnosed, the Durie-Salmon system, which was introduced in 1975, was used to stage the disease. In 2005, the International Staging System (ISS) was introduced, and it is now widely used.
The ISS categorizes multiple myeloma into three stages based on the results of two blood tests. Staging is primarily a prognostic indicator of an individual’s life expectancy. But staging alone is insufficient to determine the best treatment options. That’s why, says Kathy Giusti, the executive director of the Multiple Myeloma Research Foundation, “Everyone is now looking at how to stratify patients based on the cancer’s biology to determine who is high-risk and who is low-risk”—designations that might help doctors and patients make more informed, and personal, treatment decisions.
(photo, top: Elliot Erwitt / Magnum Photos; photo, bottom: © Arthur Siegel / Time Life Pictures / Getty Images)