C. Ola Landgren, MD: Welcome to CURE®Expert Connections®. I’m Ola Landgren. I’m chief of the Myeloma Program at Memorial Sloan Kettering Cancer Center in New York City. With me here, today, I have 1 of my patients, Aurora. Thank you so much for joining me.
Aurora Torres: Thank you so much for having me.
C. Ola Landgren, MD: Today, I want to talk about how myeloma starts off, from a symptom point of view. And then, I’d like to go through different steps in the management and the treatment of the disease. Just as a brief background, myeloma is considered to be one of the rare blood malignancies. It happens in about 50,000 individuals in the United States every year. There are slightly more people who are diagnosed every year, because the population overall is getting older and older, and because this is a disease that happens at the average age of around 70. I have a lot of patients in my clinic that I treat who are much younger. I have people in their 20s, 30s, 40s, and 50s. I also have people in their 60s, 70s, and 80s and above that, as well. There are probably more than 100,000 people living with the disease at this time in the United States. This is a reflection of the fact that once people are diagnosed, you can live with the disease for a very long time—for many years, on average. And that number is going up. More and more people will be living with this disease in the United States going forward. In your particular case, Aurora, you were diagnosed after quite a few months of having diffuse symptoms. What were the first symptoms that you actually had?
Aurora Torres: The first symptom that I had was back pain, and it was in the upper left quadrant of my back. I also had pain in my knees. If I would go up and down a series of stairs, I would feel pain in my knees. Also, there was a diagnosis by my gynecologist of a possible urine infection. When he examined me, he found blood in the urine. He gave me an antibiotic, which I took for the whole course—it was about 5 days. Then, when I went to see him again, when he took the urine, he found more blood, so, he referred me to my urologist.
C. Ola Landgren, MD: So, the first idea was that this was a urinary tract infection?
Aurora Torres: Exactly. When I went to my urologist, it was also shown that I had blood. He sent the urine out for more testing and gave me a stronger antibiotic, which did nothing. The results came back revealing that I still had blood, even after the stronger antibiotic.
C. Ola Landgren, MD: Did the pain change during this time course?
Aurora Torres: No, it did not. No.
C. Ola Landgren, MD: Many people who are diagnosed with myeloma, when they go back in—before they actually got the diagnosis—actually say, “I had back pain or pain from other parts of the body for more than 6, 9, or even 12 months.” That seems to mimic what you’re telling us here.
Aurora Torres: Right, but my pain did not increase anywhere. It stayed the same. He recommended a cystoscopy, which we had done. He said that everything looked fine in my bladder, but that there was a lot of inflammation there, which he couldn’t attribute to anything. I had an appointment a couple of months later. I left it at that. Then, I went a couple of months later to my general doctor for a physical. He took blood, and urine, and everything else that involves a physical exam. When the blood came back, he told me I had anemia and that there was something in the blood that did not look right, but he couldn’t pinpoint it. So, he recommended that I have a chest x-ray, which I did about a week later. The following day, after the chest x-ray, he called me to tell me that there was a mass. They had found a mass. He asked me to call him right away, which I did. He recommended that I go to another physician for further testing. But, in the meantime, my husband has a cousin who is affiliated with Memorial Sloan Kettering Cancer Center. He was able to make a few phone calls, and he got me an appointment with the lung doctor there. That’s how I got in to Memorial Sloan Kettering Cancer Center.
C. Ola Landgren, MD: So, the first thinking here was that this could potentially be lung cancer?
Aurora Torres: Exactly. There were tests that were done. I had a CAT scan and other exams done by this physician, and they found that it was not in the lung.
C. Ola Landgren, MD: They biopsied the mass?
Aurora Torres: Yes, they did biopsy the mass, and he didn’t tell me anything else. He just said, “I’m going to recommend you to another physician here.” That’s when the appointment was made with you, and I came in to see you.
C. Ola Landgren, MD: That’s the first time we met. You had just done this biopsy. The mass showed that there were light chain restricted plasma cells forming this mass. These were basically myeloma cells that just started growing as a round kind of mass on the inside of the rib.
Aurora Torres: It was pushing the rib. That’s why I felt the pain.
C. Ola Landgren, MD: When we met, I repeated all of the labs. I had ordered a lot of other tests. I did a bone marrow biopsy. I did imaging. We did a lot of additional tests, and we will talk about that in a little bit. Thank you so much.