Episode 108. Multiple Myeloma with Dr Jeremy Er

The term Multiple Myeloma was introduced in 1873 by von Rustizky when at autopsy he found 8 separate tumours of the bone marrow in a patient, described as soft in consistency and reddish in colour and thence called “Multiple Myeloma”. Today over 2400 Australians are diagnosed annually with Multiple Myeloma. It is slightly more common in men, with an average age of onset at 70 years. Myeloma accounts for 10% of all haematologic malignancies and about 2% of all cancers diagnosed. The five-year survival is about 51% and with improving therapy options and life expectancy, primary practitioners are very likely to be involved in the shared care of myeloma patients. Each year just over 1000 patients die as a direct consequence of this condition.

An abnormal clone of immunoglobulin-producing plasma cells is responsible for the disease. A precursor called MGUS found in 4% of patients progresses to myeloma at a rate of about 1% per year. The presenting symptoms of Myeloma may be remembered by the mnemonic CRAB standing for: Hypercalcaemia, Renal impairment, Anaemia, and Bone pain or pathological fractures.

Myeloma is not hereditary but may be influenced by radiation exposure and some viruses such as HIV. In about 80% of cases, entire immunoglobulin is secreted by the abnormal plasma cells, in just under 20% light chains only are secreted. These paraproteins may be measured by electrophoresis in the blood or urine in the case of light chains, which may be filtered through nephrons. So-called Bence Jones proteins. Less than 2% of myeloma is nonsecreting. Radiology including plain X-ray and CT, bone marrow biopsy, and cytogenetics are also essential in patient work and we will discuss this with our guest in more detail shortly.

Treatment is complex including a host of therapies such as:

· Thalidomide and Lenalidomide dexamethasone - enhancing T cell and NK cell activity

· Cyclophosphamide and Melphalan - alkylating agents

· Bortezomib - a proteasome inhibitor which inhibits the so-called garbage disposal systems within cells

· Histone deacetylase inhibitors inducing cell cycle arrest

· Monoclonal antibodies

· Radiation of bone deposits

· Stem cell transplantation

· Palliation

We will discuss these therapies as well as risk stratification and prognosis with our guest Dr Jeremy Er, haematology fellow at Peter MacCallum clinic Melbourne. There he is undertaking a PHD on Multiple Myeloma, investigating growth factors influencing myeloma, and remains very passionate about expanding our therapeutic options and success in treating Myeloma.

Please welcome Jeremy Er.

References:

Dr Jeremy Er: petermac.org

Myeloma-Causes, Symptoms and Treatments - Cancer Council: www.cancer.org.au

Myeloma.org.au

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.