While a diagnosis of multiple myeloma can be overwhelming for patients, the disease is very treatable, according to Dr. Andrew Yee.
At CURE®’s Educated Patient® Summit on Multiple Myeloma, Yee, an assistant professor of medicine at Massachusetts General Hospital Cancer Center in Boston, discussed the signs and symptoms of the disease, how it’s staged, and explored the different treatment phases a patient might go through over the course of their journey.
In 2021, Yee explained, approximately 35,000 new cases of multiple myeloma are expected to be diagnosed. While not as common as lung cancer or colon cancer, it is the second most common blood-related cancer, with 0.8% of the population having a lifetime risk of developing multiple myeloma. To put that into perspective, Yee noted, the average lifetime risk of developing breast cancer is around 12%, with lung cancer at 6%.
As with most malignancies, multiple myeloma is a disease that affects the older patient population, with the median age at diagnosis of 69 years old. And while its cause is unknown, Yee noted, chronic inflammation from infection and environmental exposures may play a role, and as such, there is no defined role for screening for multiple myeloma as there is for other malignancies. “It’s not like colon cancer, (for which) you have colonoscopies, or for breast cancer, there’s mammography,” Yee said.
There is also a small hereditary component to the disease, according to Yee, though it is not often cause for concern. While there is no specific genetic test to screen for, the risk to family members is about twice that of baseline, but still relatively low. Yee highlighted the work being done by his colleagues at Dana Farber Cancer Center on the PROMISE study, which is examining the hereditary genetic components of multiple myeloma.
When it comes to the signs of the disease, Yee reviewed the results of 1,027 patients who had been diagnosed and summed up the symptoms they presented with. Bone pain was present in 59% of patients, and fatigue was present in 32%. Twenty four percent of patients experienced weight loss, with 50% losing roughly 20 pounds or more. About 73% of patients presented with anemia, and almost 80% of patients had some abnormal skeletal findings on an X-ray, such as bone lesions (66%) or osteoporosis (23%).
“What can be challenging in multiple myeloma is that the majority of patients, when they present, they have symptoms that are very common for people in general,” Yee said. “A lot of times, patients can have these symptoms for months before the diagnosis, which is very common.”
While identifying myeloma can seem challenging, Yee said, doctors will often rely on more sensitive imaging tests such as CT scans or MRI or PET scans. He went on to note one example of a patient who had “clean” spinal X-rays but was later found to have lytic lesions, or softened sections of bone, in two vertebrae when a more in-depth CT scan was done. “This illustrates that when we see patients with multiple myeloma or concern for multiple myeloma, generally speaking, we do more sensitive imaging such as CT scan or MRI to fully evaluate the patient,” Yee explained.