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Episode #22 - Multiple Myeloma

Steve:

Hello everybody. And welcome back to Episode 22 of CCA's Medical Minute podcast series presented by Kroger Health. So I'm doing terribly in my NCAA brackets. By the way, I will remember when I look at you guys to stay right into the microphone. So if it looks weird, if I'm also slouching and kind of a little bit too over the microphone, it's because they're both things are in my head right now.


Sherry:

I need eye-to-eye, though.


Steve:

I know. I know. I have to try to remember to do this. But I do have Iowa and UK going to the Final Four-


Jill:

Oh.


Steve:

...in my bracket, which is-


Jill:

So much old for that one.


Sherry:

Iowa.


Steve:

Wish I'd have picked St. Mary's like you.


Jill:

Oh, you know what, nobody ever did tell me what color their uniforms are.


Steve:

Oh, that was Chris's job. But anyway, that-


Jill:

We'll see.


Sherry:

I don't do a good job with bracket. So I'm just going to-


Jill:

I have no knowledge-


Steve:

And who knew that St. Mary's was the number five seed? Did you know that Chris? I did not know that. That's crazy. But anyway. Because last week we talked about March being colorectal cancer awareness month.


Sherry:

Right.


Steve:

And so we had Dr. Abdul Jazieh on, who did a great job. And so this week we're going to talk about multiple myeloma awareness month, which could just as easily be called myeloma awareness month.


Sherry:

Yeah.


Steve:

And we'll explain why that is, what the multiple part of that is in just a minute. So we're going to chat about that today. So, Sherry, why don't you kick us off, reprise your role as statistician from last week-


Sherry:

Okay.


Steve:

... and kind of give us some information about multiple myeloma.


Sherry:

I will do just that. And I have my notes here. Multiple myeloma is not one of those cancers that you hear a whole lot about. In fact, I heard about it, and it kind of came across my radar when Tom Brokaw was diagnosed with it some years ago, and then everybody started hearing a lot about it. But the fact is, that you're looking at nearly 35,000 new cases of myeloma diagnosed each year in the US. And in addition to that, those are new cases. There's 140,000 Americans-


Steve:

Wow.


Sherry:

... walking around today that are either currently battling the disease or in remission from it.


Steve:

Okay.


Sherry:

And although there are all of these folks that are dealing with it, 12,000 Americans will lose their fight with this disease. But there is some good news.


Steve:

Okay.


Sherry:

And you're talking about the stats on this. As recently as the early 1960s, the five year survival rate for myeloma was only about 12%.


Steve:

Wow.


Sherry:

That's the 60s. Right. So fast forward to 2016, the five year then survival rate of myeloma had increased to almost 70%. It was 69%.


Steve:

Wow. Okay. Well that's great news.


Sherry:

And for those that are under the age of 45, the five year survival rate went up even more, it approached about 80%.


Steve:

Okay.


Sherry:

That's huge.


Steve:

Well hopefully, maybe that is why we don't hear as much about it. I hope that's the reason why. But one thing I wanted to mention, and Jill, you can back me up on this or correct me, but you always hear these five year survival rate statistics. And I remember kind of early on in my own research, I kind of interpreted that as meaning the odds that you're going to live five years. Well, I think one thing is that it's worth pointing out, because that's kind of the way it's always expressed is the five year survival rate, that does not mean you're only going to live five years. And so that's just kind of the way they measure it. Correct? I mean, that's kind of the way it's always reported?


Jill:

Correct. Statistically looking at five year survival, you're looking at a disease as a whole, so you're not looking at the specific nature, you're really compartmentalizing. So from the diagnosis of multiple myeloma, from point A to point B, at the five year mark, what percentage of patients are still alive-


Steve:

Okay.


Jill:

... at that point. It doesn't take into consideration if they have a more aggressive biology, it doesn't take into consideration how advanced the disease was at the time of diagnosis or how little of disease you could have had at diagnosis.


Steve:

Yeah.


Jill:

So when you get to, for young people who have the almost 80%, you still have 20% in that age group.


Steve:

Yep.


Jill:

But those typically tend to be the patients that are more aggressive.


Steve:

Yeah. And that was kind of the point I wanted to make is that, let's say, for example, if you live 20 years, it's not like you get extra credit in the statistics. I mean that still counts as one.


Jill:

No.


Steve:

That's more than five years.


Jill:

No. But you should definitely get a crown or a jewel in your tiara because you're-


Steve:

True.


Jill:

... living 20 years with myeloma and we have patients that have done it, but it's not without bumps in the road.


Sherry:

Okay.


Steve:

Oh man. Wouldn't that be hard?


Sherry:

And we might want to add that for those that are listening.


Steve:

Waah, waah.


Sherry:

When you talk about myeloma, you're talking about plasma, you're talking about the blood. So it's a blood, a cancer of the blood. Right?


Jill:

Right.


Steve:

Yeah. So, okay. So that's something too. See, one of the perks of being the host is that you don't really know whether I'm playing the role of a stupid guy or I'm actually just a stupid guy. So I got that going for me. So plasma, other than people selling plasma in order to buy things that they probably shouldn't buy, like booze and stuff. What is plasma? What role does plasma play?


Jill:

So plasma and plasma cells are two totally different things.


Steve:

See, okay, here we go.


Jill:

So multiple myeloma is a malignancy of the plasma cell, which it's derived from the B cells or the lymphocytes.


Steve:

Okay.


Jill:

A type of lymphocyte. What the plasma cell is responsible for is it makes antibodies.


Steve:

Okay.


Jill:

So the plasma cell is crucial in fighting infection.


Steve:

Okay.


Jill:

Fun fact, if you're a total of science geek, if you look at plasma cells underneath the microscope, they are the prettiest shade of purple.


Steve:

Really?


Sherry:

Really?


Jill:

Yes.


Steve:

Are they like snowflake? But they're like purple snowflake?


Jill:

Not like snowflakes.


Steve:

Okay.


Sherry:

Purple rain, maybe.


Jill:

No. Purple-


Steve:

Purple rain.


Jill:

Pretty purple little circles. But yeah. And what happens with multiple myelomas then, those plasma cells, something goes wrong and they mutate, and ultimately it's like the copier getting stuck on-


Steve:

Okay.


Jill:

...on copy of those bad cells and they start replicating.


Sherry:

Replicating.


Jill:

Yep.


Steve:

And we've talked about that before. I mean, is that at a base level, is that kind of always what cancer is just over-


Jill:

Overproduction-


Steve:

... production-


Jill:

... of bad cells.


Steve:

... of bad cells that crowd out the function of the good cells.


Jill:

Yes.


Steve:

Okay. All right. So then, so what we see there is you're a little bit compromised, more prone to disease, because your immune system's not functioning as well. Is there anything else that's kind of attendant to myeloma that's probably worth mentioning?


Jill:

So a lot of patients who are initially diagnosed with myeloma, they'll have bone pain or something's not right. And those mutated plasma cells, they really mess with the checks and balance system in our bone health.


Steve:

Okay.


Jill:

There's just a normal process that happens in the body that takes care of getting rid of old bone kind of taking that away, and then replenishing and restoring healthy new bone. Well, the plasma cells mess with that balance. And then they also pull the calcium from the bone.


Steve:

Okay.


Jill:

And it leaves these little soft spots. And so then they show up as bone lesions, but they present as pain.


Sherry:

Wow.


Steve:

Oh, interesting. Okay. That's-


Sherry:

Actually, well, anytime you mention bone, you start thinking of things like osteoporosis, which I'm sure that's going to play a factor in this. But while we're talking about all this, what are some of the risk factors, Jill, that people should be aware of for this disease?


Jill:

So like with most of the cancers, one of the biggest risk factors is age. As you get older, your risk goes up. So patients who are over the age of 50. Men get it more than women, and African-Americans are twice as likely as whites to get-


Sherry:

It seems like-


Jill:

... multiple myeloma.


Sherry:

... we're always twice as likely.


Steve:

It's a common theme. I know.


Jill:

Twice as likely.


Sherry:

What's going on? As everything. Okay. We have to do more research.


Jill:

And then one preexisting condition for a patient that puts them at higher risk for multiple myeloma is if they have a history of MGUS, which stands for monoclonal gammopathy of unknown source.


Sherry:

Say that again.


Steve:

Ah. Wait, wait, wait, wait.


Sherry:

Monoclonal-


Jill:

Gammopathy-


Sherry:

... Gammopathy.


Jill:

... of unknown source.


Steve:

I don't think we've done a movie reference in an episode or two.


Sherry:

Uh-oh. Movie.


Steve:

So.


Sherry:

Do we have some sound? We'll talk to Chris. Chris, whenever he has a movie reference, we need to come up with a sound.


Steve:

Or at least a graphic. At least a graphic.


Jill:

Or at least an image.


Sherry:

Or something.


Jill:

We need an image for this one.


Sherry:

Yeah.


Steve:

But what I'm thinking about here is rodents of unusual size.


Sherry:

Oh.


Steve:

From Princess Bride.


Sherry:

Rodents.


Steve:

As opposed to-


Jill:

As you wish.


Steve:

... monoclonal gammopathy of unknown significance.


Jill:

Yes. Yes. Nice. Nice.


Steve:

All right. So anyway, I'm sure I added some value there. So go ahead.


Jill:

Also, patients who have had previous exposure to radiation, and there are certain chemical exposures that can make you at increased risk. Obesity, just like it does with quite a few of the cancers, it increases your risk for multiple myeloma as well. And then chronic immunodeficiency is another.


Sherry:

So earlier, I was mentioning something like osteoporosis. If someone has osteoporosis, are they at more of a risk, as well?


Jill:

Osteoporosis itself does not increase the risk.


Sherry:

Okay.


Jill:

However, on the flip side of that, because you're impacting the bone with this disease, patients do have an increased risk of fracture because the bone's not stable in areas where those lesions are. So a lot of patients, part of their treatment plan will be a bone strengthener. Drugs like Zometa or Xgeva-


Steve:

Okay.


Jill:

... things like that to help-


Steve:

Okay.


Jill:

... with strengthening that surface of the bone.


Steve:

Prolia. Is Prolia one of those?


Jill:

Prolia's one as well.


Steve:

Okay. Okay.


Jill:

There's a whole laundry list of those.


Steve:

Gotcha. I mean, Sherry, would you agree? I think we've come a long way.


Sherry:

Yeah.


Steve:

We've talked about some reasons to be hopeful, I think based on the statistics.


Sherry:

Yeah.


Steve:

One thing I wanted to mention, I called Tom Carlton this morning. He's with Leukemia and Lymphoma Society and chatted with him about it, too. And I think he kind of shared a similar opinion and he told me, I guess that there's another CAR T trial out that is looking at, I think that will present some hope as well for people that are dealing with this. CAR T being an immunotherapy treatment.


Jill:

Yeah. And that'll definitely be great to talk about in 102, because the trajectory for treatment, the gold standard has always been, you do treatment to get to stem cell transplant.


Steve:

Okay.


Jill:

And then now with the addition of the research that's been done with CAR T, they're really seeing a lot of disease control in multiple myeloma with CAR T.


Steve:

Okay.


Sherry:

Yeah.


Jill:

So we'll dig into that a little bit more in our next episode.


Steve:

Okay.


Sherry:

And it really does come down to the research. I mean, there's so much good research that's going on out there.


Steve:

Yeah.


Sherry:

So hopefully some of these statistics will continue to improve and change.


Jill:

Yep.


Steve:

Yeah.


Sherry:

Well, we're down here to the end of the-


Steve:

Are you going to bring us home, Sherry?


Sherry:

Yeah. We're going to bring it on home. Of course, thank you for joining us and make sure that you join us again next week when we're going to be discussing kidney cancer and things that have to do with that.


Steve:

Yep.


Sherry:

But as always, if you haven't already, please, please go ahead and share this-


Steve:

Yep.


Sherry:

... and subscribe-


Steve:

Yeah.


Sherry:

... to our Medical Minute podcast series, because it really does, we have fun, but it is very helpful to a lot of people out there dealing with cancer.


Steve:

Yeah.


Jill:

And even if you don't watch it to get good medical knowledge, at least you'll get at least one good movie reference.


Steve:

That's true. That's true. Good point.


Sherry:

That's right.


Steve:

Very good point. So, yeah. So join us back here next week, when I will literally have probably zero teams left in my NCAA bracket at the rate that things are going.


Sherry:

It'll be interesting to see how you do over the next week, here.


Steve:

Jill will share, we can maybe find a way to spend your winnings-


Jill:

My winnings.


Steve:

... when St. Mary's takes it all.


Jill:

Makes it to the Final Four.


Steve:

That's right. All right. Well, thanks everybody. And, we'll see you back here next week.


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