March – the Month for Minds to dwell on Multiple Myeloma

R. M. Subbaih*

Consultant Hemato-Oncology, Kauvery Hospital, Trichy, India

*Correspondence: [email protected]

March is Multiple Myeloma Awareness Month

Multiple myeloma is a malignancy of plasma cells which are an important component of immunity.

Overall survival has increased significantly over the last two decades with availability and increased accessibility to novel agents.

More awareness about suspecting the disorder has also yielded increased incidence, early diagnosis, and reduction in morbidity and mortality.

Any disorder with insidious onset and gradual progression is a threat, it inflicts irreversible damage to the system.

It’s a clinic-pathological and radiological diagnosis requiring all three aspects to be evaluated to rule in or out the condition.

International Myeloma Working Group (IMWG) has published diagnostic and treatment response criteria.

It must be suspected in a patient with classical presentation (bone pain, pathological fracture, cast nephropathy, hypercalcemia) or nonclassical presentation (unexplained anemia, hyperviscosity syndromes).

CRAB criteria representing hypercalcemia, renal failure, anemia, and bone lesions are an easy way to look for clinical features in a suspected patient.

After establishing the diagnosis as per IMWG (international myeloma working group) criteria, cytogenetics and FISH (fluorescent in situ hybridisation) would help in picking up genetic abnormalities of plasma cells and henceforth risk categorisation.

The international staging system categorises patients into three prognostic groups.

All symptomatic patients warrant treatment, whereas amongst asymptomatic patients some may require treatment (high-risk smoldering myeloma. Transplant eligibility (up to 65 years of age with good physical performance) is an important call to be taken while commencing therapy.

Triple therapy (proteasome inhibitor, immunomodulatory agent, and a steroid) holds good as a first-line regimen.

Eligible patients are induced to achieve a clinical response (improvement of clinical symptoms, reduction in paraprotein levels, recovery of end-organ damage). At least a partial response (50% reduction in paraprotein levels) should warrant an autologous stem cell transplantation in an eligible patient.

The transplant can be offered immediately once a clinical response is achieved (usually four cycles of induction) or at the relapse.

Other novel agents (monoclonal antibodies, checkpoint inhibitors, CAR T cells) form the next line of management if front-line therapy fails.

Sometimes a very high-risk patient with 17p deletion might require a tandem (double) transplant to improve outcomes.

Transplant ineligible patients are continued on recommended regimen, watching clinical progression, and also monitoring for adverse drug effects.

At Trichy Kauvery Hospital we have started bone marrow transplant services since July 2020. Among transplant eligible patients especially during the COVID-19 pandemic, nine patients have undergone autologous BMT over 15 months. Three of them had chronic kidney disease, one underwent a tandem transplant in view of refractoriness to therapy.

The mission of the IMWG is to conduct collaborative basic, clinical, and translational research to improve outcomes for myeloma patients while providing scientifically validated, critically appraised consensus guidelines for the myeloma community globally.

Myeloma Action Month happens every year in March to encourage individuals and groups to take actions that positively impact the myeloma community.

This year, the international myeloma foundation is focusing on actions that individuals and groups can take for the myeloma community to draw attention to the disease and to inspire a culture of hope and resilience.

Genomic landscape and therapeutic availability have seriously impacted the survival of myeloma patients.

Myeloma still remains one of the most common disorders that a haematologist confronts when starting transplantation services at a new centre. It brings hope to both the patient and the new stem cell transplantation initiative.

Dr.-R.-M.-Subbaih

Dr. R. M. Subbaih

Consultant Hemato Oncology

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