Reviewed by Laura Martin on March 23, 2017
Sagar Lonial, MD<br>Oncologist and Chief Medical Officer at Winship Cancer Institute
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Sagar Lonial, MD Oncologist: Multiple myeloma is a plasma cell disorder, and plasma cells are cells that live within the bone marrow
and their job is to make antibodies.
So, when you get sick or you get a vaccine,
the cells that make those antibodies that protect you over the next five years,
ten years, fifty years are plasma cells. In myeloma, those cells become cancerous.
Sagar Lonial, MD Oncologist con't: Probably the most common things that we see patients present with are fatigue, weakness, bone pain…
sometimes we hear about inability to concentrate, those kinds of thing.
But those are probably the biggest that people will present with.
Sometimes patients will present with fractures, so it can be an arm, a leg…
most often it presents in the spine and so significant pain can be associated with that.
Sagar Lonial, MD Oncologist con't: In order to make the diagnosis of myeloma, there are a couple of tests that we do.
The first is blood tests, the second is a twenty-four hour urine collection,
X-Rays would be another test that we would do, and the fourth would be a sample of the bone marrow.
When a patient is ready to initiate treatment for myeloma, there are a couple of roads that one can go down
and the first question that comes up is: Is the patient eligible for a transplant?
Sagar Lonial, MD Oncologist con't: And when we talk about a transplant – we're talking about autologous stem cell transplant, meaning their own cells.
And there's a level of function and wellness that's required to be able to go down that road.
The second is the ability to tolerate aggressive treatment. Aggressive therapy,
to me, means at least three drugs in combination -- with the intent of using transplantation at some point.
The third is bone-strengthening medicine, such as zoledronic acid to try and prevent skeletal events.
Sagar Lonial, MD Oncologist con't: And, the fourth is the role of radiation or additional chemotherapy agents.
When patients respond to treatment, there are different levels of response,
but one of those levels is a complete remission – meaning that we can't detect the disease.
Now that doesn't mean that it's not there and that's one of the important things that I think both patients
and community oncologists need to be aware of. That is, when we say CR, or complete remission,
Sagar Lonial, MD Oncologist con't: if you stop treatment, the disease will almost always come back.
So, just being satisfied with achieving a complete remission is not the end point.
Our goal is chronic, long- term suppression, if we're going to eliminate the cells in total.
Make sure you get to a place that sees a lot of this because the field is moving
so fast that you don't want your doc to be the one who didn't get the memo. Right?
Sagar Lonial, MD Oncologist con't: I mean, you want to be treated with the most aggressive
and advanced treatment options that are available at any given time.
And there are probably 10 or 15 centers around the country that really focus on myeloma
and that's where you wanna be. Or at least have an opinion from somebody at that place.