By Dr. Peter Byeff

The prognosis for multiple myeloma is gradually improving as a result of new and improved therapies.

Multiple myeloma, which causes cancer cells to accumulate in bone marrow, can affect people of all ages, although the average age of onset is the sixth decade of life. New treatments including high-dose chemotherapy with stem cell support for appropriate patients, drugs in the classes of proteasome inhibitors, IMiDs (Immunomodulatory imide drugs) and other monoclonal antibodies such as daratumumab as well as bisphosphonates, which help to decrease skeletal-related events, have had a very significant impact on quality of life and survival.  Nonetheless, survivors face a number of challenges.

Long-term toxicity from treatments include neuropathy due to several of the new classes of drugs. Although it is an uncommon side effect, bone injury of the jaw secondary to treatment with bisphosphonates, can create very significant toxicity, which requires additional therapy.  Survivors also often have altered immunity, which makes them susceptible to a variety of infections.  The altered immunity may be due to myeloma itself, which often is accompanied by severe background suppression of the normal immune system and is sometimes treated by immune infusions that are given monthly.  Additionally, decreased immune response may be secondary to high dose chemotherapy with stem cell support or to drugs such as steroids which are used to treat myeloma.

Bone health is another issue for myeloma survivors.  They often have osteoporosis and involved bone lesions that may fracture. They often continue to receive medications to help bone health for a prolonged period to decrease the risk of a skeletal-related event.  Continued monitoring of the skeletal system is necessary.

Survivors of myeloma not infrequently will have diminished kidney function that may have been caused by the myeloma protein or elevated calcium levels in the blood. They may require continued surveillance for this. Decreased renal function may cause chronic anemia and may require treatment with agents such as epoetin to maintain an adequate red blood count.

Long-term survivors of myeloma are at significant risk of developing myelodysplasia, a chronic condition of white blood cells that may transform into acute leukemia, or acute leukemia itself due to the combined effects of therapy.  Survivors need continual monitoring of their blood counts to assess for any blood cell abnormalities.

The need for ongoing monitoring and treatment with these new cadre of medications may provide significant economic challenges to survivors due to the costs of these therapies. The Hartford HealthCare Cancer Institute offers financial and psychosocial counseling to help support patients and families during their cancer journey.

Dr. Peter Byeff is a Hartford HealthCare oncologist.

For more information on the Hartford HealthCare Cancer Institute and multiple myeloma, click here.