Cristina Gasparetto, MD, gives a brief overview of the multiple myeloma disease state and introduces us to Donna, one of her patients diagnosed with multiple myeloma.
Cristina Gasparetto, MD: Hello, and welcome to Cure Expert Connections®. My name is Cristina Gasparetto, and I would like to welcome one of my patients, Donna, who is here to share the story of her journey with multiple myeloma. Welcome, Donna.
Donna Kidder: Thanks, Cristina.
Cristina Gasparetto, MD: Before I ask you questions, let me explain briefly what myeloma is. It’s a blood cancer. It’s the second most common blood cancer after lymphoma. Lots of my patients come to the office and have never heard about myeloma, but then they realize that it’s more common than they thought. It’s more prevalent in men than women. Among African Americans, there is a prevalence in these patients, mainly African American men.
Believe it or not, the average age of diagnosis is in the late 60s. However, we have seen a trend toward a younger population over the last 20 years, and we don’t know why. Unfortunately, when we think about typical patients with myeloma, we always think about older patients and men more than women, like I mentioned. So you really did not fit the typical patients with myeloma. When were you diagnosed, and what were you doing at the time? What was your life at that time? And tell us a little about your symptoms and the reason why you decided to seek medical attention.
Donna Kidder: My story is a little unusual in that I really didn’t have any symptoms. I was diagnosed in May 2012. In April 2012, I was in Washington, D.C., doing the Cherry Blossom Ten Mile Run. Clearly, I wasn’t having the typical symptoms. But I had decided to ask my doctor to check my bone density because I’d been on Boniva for a year, and I wanted to make sure it was working. Also, I had my blood work done. Two things showed up: My bones had decayed faster than could be explained with osteoporosis, and there was protein in my blood. The next thing I knew, I was being sent to a hematologist. That’s how it was described to me. But I googled those two symptoms and found multiple myeloma. I suspected that I had multiple myeloma before I went in to see the doctor, even though I had no symptoms.
Cristina Gasparetto, MD: At the time, you were very active. You’re still very active. Donna and I have a lot in common with life. We like the outside, we like biking, in particular. We belong to the same biking team, actually. I would say that one-third of patients with myeloma will actually present like you. They don’t even know they’re sick, that they’re diagnosed with myeloma during a routine physical examination, visits, blood work. The most common abnormality that you see in the blood work is sometimes mild anemia.
For a patient like yourself, who’s very active, you probably didn’t even feel it. If you had a little anemia, you were racing, as you said. Then the protein, the myeloma cells, and the lymphocytes are mature. Their job is to produce antibodies. Antibodies are protein, and the myeloma cells all produce the same type of antibody, which becomes the marker of your disease. This is a protein that’s detected in the blood, and some patients are eliminating the protein through the urine. Having proteinuria, high protein in the urine, is one of the hallmarks of the disease.
The majority of patients will present with bumping—bone degeneration, as you had. We all go through bone destruction and bone regenerations every month. We have new bone and new bone destruction. After seven years, we have a new skeleton. In patients with myeloma, that cycle is broken. The myeloma cells are causing disruption of the cycle, so patients are losing bone, and they’re not making new bones until they’re back in remission. If you take the x-rays of patients with myeloma, you’ll see the classic lytic lesion, all the destruction of the bone: anemia, bone destruction.
The protein you’re producing, the antibody, can cause obstruction in your kinase. The kinase is a big filter. The protein obstruct the kinase, and so they cause some kinase sufficiency. There are other mechanisms of action, but that’s the classic myeloma kinase. Bones are made with calcium, so the calcium can be elevated in your blood. Those are the majority of patients who will present with bone destruction, high calcium, anemia, some renal insufficiency. As I said, one-third of patients present, like you, with no symptoms. During an incidental finding, I always recommend to be checked periodically, having blood work. It’s very important. But if you have any symptoms—bone pain, unusual bumping—that don’t get better, it’s worth it to seek medical attention and make sure that you have the proper testing: blood work, hemo gene, etc.
This transcript has been edited for clarity.