mCancerPartner sat down recently with Daniel Couriel, MD, a professor of hematology and oncology to discuss multiple myeloma treatment options. Dr. Couriel treats patients with blood disorders such as multiple myeloma and he is an expert on graft-versus-host disease, a complication of stem cell transplantation. Dr. Couriel is participating in a round-table discussion at the upcoming Wine and Dine in the D, an annual fundraiser to benefit the Multiple Myeloma Research Foundation. It takes place Thursday, Sept. 19 at the Westin Book Cadillac Hotel in Detroit.
mCancerPartner: Dr. Couriel, what is multiple myeloma?
Dr. Couriel: This is a kind of cancer that most often is found in the elderly. It affects a subset of blood cells called plasma cells, which normally live in bone marrow, the same place where all blood cells are generated. With multiple myeloma, too many plasma cells become malignant, and proliferate without restraint. This prevents other kinds of blood cells – like red blood cells – from growing. As they get crowded out, the number of red and white blood cells go down, and this has serious side effects: we all need white blood cells to fight off infection, and red cells to transport oxygen.
Other serious problems occur when the malignant plasma cells cause bone disease and erosion, and the calcium from the eroded bones enters the blood stream. The bones become increasingly brittle, so patients’ bones are easily fractured. And protein from the malignant plasma cells winds up in the blood and sometimes this causes kidney damage.
mCancerPartner: Do we know what causes multiple myeloma?
Dr. Couriel: No, we don’t. There are a small number of people who appear to have a family inheritance pattern, but generally, we don’t know yet what causes this cancer.
mCancerPartner: How is multiple myeloma treated?
Dr. Couriel: There has been an explosion of different treatments in the last several years. There are two approaches. One involves taking medication and the other involves receiving a stem cell transplant, usually of the patient’s own stem cells. These approaches work best when used together, and doctors usually specialize in one or the other. So it is very important for the two types of doctors to work together on a patient’s treatment plan.
mCancerPartner: What does a bone marrow transplant entail?
Dr. Couriel: Today, this is a very safe procedure that involves a blood transfusion of stem cells, rather than a surgical operation. In fact, we call these stem cell transplants now and the mortality rate is less than 5%. We begin by collecting stem cells, usually from the patient, and freeze them. Once we have enough, we usually admit the patient, although some stem cell transplants are done on an outpatient basis. The patient receives a high dose of chemotherapy to wipe out both the bad, malignant cells and all the good blood-forming cells. Then we thaw the stem cells and put them back into the body through a regular transfusion. The stem cells get back into the patient’s bone marrow on their own. It will take 12-15 days for the stem cells to take hold and begin producing healthy blood cells again. Because of the chemotherapy, patients are more vulnerable to infections and are probably experiencing side effects to the chemotherapy, such as flu-like symptoms, diarrhea, mouth sores and so on. So our patients stay in the hospital for 2-3 weeks after the stem cell transplant so we can keep them comfortable and treat the complications from high doses of chemotherapy.
mCancerPartner: What is the prognosis for people with this kind of cancer?
Dr. Couriel: In general, there are two factors that help us predict prognosis. The first is how advanced the cancer was when it was discovered. This is called ‘staging.’ The second factor is what the dna in the malignant plasma cells tells us. By analyzing the dna, we can tell if a person’s prognosis is likely to be good, somewhere in the middle, or not so good. Most patients are in the middle risk category. There’s no cure for multiple myeloma, but essentially, the new era of treatment we are in means that most patients may have a good prognosis and live for years.
Learn more about Multiple Myeloma
Bone Marrow Transplant Program at the U-M Comprehensive Cancer Center
Multiple Myeloma Information at the American Cancer Society
More than 200 adult BMT procedures are performed at U-M each year – making us one of the largest programs in the state. That level of experience means that U-M transplant specialists know what to recommend for each transplant candidate, what to expect from each procedure, and how to respond to every challenge that may arise on the transplant journey. Our dedicated team of doctors, nurses, physician assistants and transplant coordinators are specially trained in and solely devoted to stem cell transplantation.
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