UAB’s Multiple Myeloma Clinic got its impetus when one of its bone marrow transplant physicians began noticing unsolved mysteries concerning the blood cancer.
Hematologist -oncologist Racquel Innis-Shelton, MD, now medical director of the clinic, observed that a high percentage of UAB’s bone marrow transplant patients with multiple myeloma were African American. She did some checking and learned that twice as many patients with African origin develop the disease than those of European descent. “It’s not yet known whether that health disparity is primarily genetic or environmental or a combination of the two,” she says. “We hope that the clinic will create awareness and generate data that will help increase our understanding and produce ever better treatment options over time.”
An assistant professor in the UAB Division of Hematology and Oncology, Innis-Shelton was struck early on by how painful and debilitating multiple myeloma can be for many patients who suffer it and related ongoing chronic illnesses including kidney disease and osteoporosis. “Multiple myeloma patients often live a long time with their disease and can become progressively debilitated,” Innis-Shelton says. “Drugs used to treat the disease can create other challenges.”
While less common than blood cancers leukemia and lymphoma, the National Cancer Institute, estimates about 78,000 myeloma sufferers across the country. The vast majority have multiple myeloma, which affects multiple sites of the body. For some multiple myeloma patients, symptom development - including fatigue, anemia, weakened immune system, kidney damage and bone loss in the spine, pelvis, ribs, shoulders and hips - is rapid. For others with asymptomatic, or smoldering, myeloma, the disease progression is slow and goes undetected.
When the plasma cell disease flares periodically producing an overabundance of malignant melanoma cells in the bone marrow, chemotherapy and bone marrow transplants often become necessary. “Each person has a unique response and needs individualized treatment,” Innis-Shelton says.
In addition to being African-American, other increased-risk factors for multiple myeloma include being over the age of 50, being male, obese, having been exposed to radiation, and having worked in petroleum-related industries.
Multiple myeloma often goes undetected until significant symptoms develop but a marker associated with the cancer may be uncovered early during a blood test. The paraprotein that signals monoclonal gammopathy of undetermined significance (MGUS ) may be found in the blood during standard laboratory tests. MGUS occurs in an estimated three percent of people over 50 years old. “MGUS transforms to symptomatic myeloma one percent per year or in other words, the probability of transformation is 25 to 30 percent over a 25-year time period,” Innis-Shelton says. “MGUS patients must be monitored periodically to determine whether they have developed myeloma.”
It’s important to detect symptomatic multiple myeloma as early as possible and get patients to the right specialists to help lessen effects such as anemia, bone loss and kidney disease. “About 80 percent of multiple myeloma patients have bone disease,” Innis-Shelton says. “Some patients may suffer so much bone loss over time that they become paralyzed.”
Because of her growing interest in the disease, Innis-Shelton was encouraged to collaborate with other UAB physicians who treated multiple myeloma patients to develop a team approach. “When I proposed the idea members of what would become our multidisciplinary team started coming out of the woodwork,” she says.
Discussions about the clinic began in the fall of 2012. Last March the clinic, sharing resources with the UAB Comprehensive Cancer Center, opened. Since then referrals to UAB for multiple myeloma have doubled. So far 160 patients have received treatment. “With a centralized clinic we’re bringing greater visibility to the disease and offering more extensive treatment options and opportunities for our patients to be able to participate in clinical trials,” Innis-Shelton says.
The clinic is providing multiple myeloma patients with a team of physicians board certified in the hematology/oncology, bone marrow transplantation, nephrology, interventional radiology, radiation/oncology and orthopedics. “Our consultations will include a streamlined, comprehensive assessment with therapeutic recommendations to myeloma patients from the time of initial diagnosis throughout their treatment course. We’ll be able to identify patients with high-risk features early on and determine eligibility for clinical trials and disease-specific interventions,” Innis-Shelton says.
Innis-Shelton wasn’t thinking of becoming a medical director when she first began puzzling over certain aspects of multiple myeloma, but is thrilled her interest is leading to increased hope for those who suffer from the blood cancer. “It’s exciting that patients will now have access to this first-of-its-kind multidisciplinary facility in Alabama with a comprehensive plan of care including systemic therapy, pain control and supportive care measures for optimal management of this disease,” she says.