How has myeloma treatment improved over the last few years?

Myeloma, a type of blood cancer, has seen major advances in treatment in recent years, with patients living longer and with a better quality of life. We interviewed Dr Jonathan Sive, an expert haematologist who works at the forefront of myeloma treatment, for an inside look at the latest treatments available.

What are the first signs of myeloma and how is it diagnosed?

Myeloma (or Multiple Myeloma) is a type of blood cancer which can cause anaemia (low haemoglobin levels), high blood calcium levels, poor kidney function and bone damage.

The first signs are usually fatigue,bone or back pains, kidney damage or recurrent infections.

Myeloma is occasionally detected on a blood test or scan that was carried out for another reason. It usually causes a raised abnormal "monoclonal" protein level in the blood, which can be used to monitor response to treatment, as well as detecting recurrence or progression after a response to treatment.

You will usually require a bone marrow biopsy to confirm any diagnosis , as well as scans to assess the extent of any bone damage that may have occurred.

What is MGUS?

MGUS stands for Monoclonal Gammopathy of Uncertain Significance. It is benign condition that is commonly picked up on routine blood tests, especially as people get older. An abnormal protein is detected of the same type as in myeloma, but as long as there is no evidence of damage to the body, no treatment is required.

In the majority of cases MGUS never causes any problems , but in a small proportion it can transform into myeloma or occasionally other blood conditions, and so once detected it usually requires monitoring.

What treatments are available for myeloma?

There are increasing number of different treatments now available for myeloma. These include:

• Steroids
• Traditional chemotherapy drugs such as cyclophosphamide and melphalan,
• "Proteasome Inhibitors" such as Bortezomib (Velcade) or Carfilzomib,
• "Immunomodulatory Drugs" such as Thalidomide and Lenalidomide (Revlimid),
• Antibody therapies such as Daratumumab.

These drugs are often given in combination to give maximum benefit, and can usually be given through clinics and day units, rather than on a hospital ward.

Patients who are fit enough may be offered an autologous stem cell transplant (also known as high dose therapy or autograft). This is a more intensive treatment requiring admission to hospital for a few weeks, but can be very effective at keeping myeloma in remission for a prolonged period of time.

What advancements have been made in recent years in treating multiple myeloma?

In recent years there have been a number of major advances in the treatment of myeloma, with the development of new classes of drugs such as proteasome inhibitors and immunomodulatory drugs.

One of the most exciting recent developments has been the use of monoclonal antibody therapies such as Daratumumab which is highly effective, especially when used in combination with other drugs.

The management of drug side effects continues to improve, with a better understanding of how to use these treatment combinations more effectively and safely.

In addition, there is now improved use of “supportive care”, including drugs such as Zoledronic Acid (Zometa) for reducing the risk of bone fractures, as well as antibiotics to prevent infections occurring.

All of these factors have led to better outcomes for patients with myeloma. Although it unfortunately remains the case that there is no cure for the vast majority of patients with myeloma, people are now living longer and with a better quality of life than ever before.