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Staff Oncologist, Mayo Clinic Arizona

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1 Staff Oncologist, Mayo Clinic Arizona
Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Alan Bryce, MD Staff Oncologist, Mayo Clinic Arizona

2 Multiple Myeloma - Background
The Bone Marrow (blood factory) makes 3 kinds of cells: White Blood Cells …immune system Red Blood Cells (Hemoglobin) …carry oxygen Platelets …clotting There are several kinds of white cells in the marrow usually 1-3% of them are PLASMA CELLS plasma cells make good proteins – antibodies or “immunoglobulins” which help fight infection

3 Multiple Myeloma - Introduction
Myeloma is a cancer of the Plasma Cells They grow out of control in the bone marrow (at least 10% and as high as nearly 100%) This results in many problems including: Low hemoglobin (anemia) and platelets Elevated abnormal immunoglobulins (proteins) Bone pain and fractures Infections (partly due to low normal immunoglobulins) Kidney problems Other complications…

4 Spectrum of Myeloma Asymp- Normal Active Myeloma Aggressive tomatic
plasma cell MGUS Aggressive Myeloma Active Myeloma Monoclonal gammopathy of unknown significance

5 How do plasma cells become “evil”?

6 Multiple Myeloma – Causes?
The cause of myeloma is still unknown Some have suggested: Radiation- Nuclear Bomb Survivors Chemicals (benzenes), herbicides and insecticides- The “Myeloma Belt” Genetics or even viruses Familial Myeloma – still rare However, nothing is conclusive, and it is likely a combination of many factors…

7 Multiple Myeloma Unfortunately, MM is not a curable disease (yet!!)
Historically most people did not live for much more than 2 years… However, the average survival is now at least 8 years This has been a result of three key developments: 1. Early Detection 2. Autologous Stem Cell Transplant 3. Novel Drugs (thalidomide, bortezomib, lenalidomide)

8 Multiple Myeloma - Epidemiology
Incidence It is a rare condition, occurring in about 4 people per 100,000 (1% of all cancers) About 2100 new cases this year in Canada It is more common in men than women It is more common in the black population Average age of diagnosis is 65 Less than 10% of cases occur in patients <50 Less than 2% of cases occur in patients <40

9 Myeloma rate in Arizona among race groups, 1995-2009

10 Common Symptoms Not all patients will have all of these symptoms
Fatigue Mostly due to low hemoglobin (anemia) Also due to disease itself Other factors contribute to this (psychological, chemo & other drugs, infections…) Lack of Appetite Infections Due to weakened immune system

11 Common Symptoms contd. Bone Symptoms
The abnormal protein causes an imbalance in bone production leading to bone thinning This bone loss can lead to osteoporosis, bone pain and bone fractures Most common location is the spine High Calcium levels Often happens when first diagnosed (calcium released by damaged bones) Can result in thirst, nausea, vomiting, frequent urination, confusion and even coma

12 Common Symptoms contd. Impaired Kidney Function
The abnormal protein and the high calcium can damage the kidneys About ½ of patients have some degree of kidney damage Some have severe damage and require dialysis Neurological symptoms Bone fractures may compress nerves and cause symptoms Easy bruising & bleeding occurs in some

13 Diagnosis of Myeloma The diagnosis of Myeloma is made as a result of several tests: Blood Counts (CBC – white, red, platelets) Blood and urine tests for immune proteins 3. Bone Marrow tests (aspirate and biopsy) 4. X-rays 5. Other blood tests

14 Myeloma Treatment Principles of therapy
1. Stop the production of the abnormal plasma cells (chemo) 2. Strengthen the bone and prevent fractures 3. Increase the hemoglobin count and reduce fatigue 4. Reduce risk of infections 5. Promote well being and quality of life

15 Treatment with Chemotherapy
Goal is to reduce the number of plasma cells and the proteins they produce Timing is important as it may be possible to wait & watch It is not “curative” but may put the disease into remission Must be tailored to individual based on disease factors (type, severity, organs involved) and patient factors (age, general health…) Stem Cell Transplant is a common treatment option

16 Conclusions New Treatments for myeloma have improved survival
Myeloma is usually preceded by many years of MGUS Screening and early detection can allow therapy to begin before organ damage develops Bone Marrow transplant and Clinical Trials should be considered when appropriate

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