Madrid, September 7, 2021- Multiple Myeloma (MM) is a type of hematological cancer that affects 3-5 people per 100,000 inhabitants every year in Spain and represents 10% of malignant hemopathies. "It is a type of bone marrow cancer defined as an abnormal proliferation of plasma cells that produce a paraprotein in serum and/or urine," explains Dr. Rebeca Iglesias del Barrio, head of the Multiple Myeloma and Gammopathies Unit with the Hematology and Hemotherapy Service at MD Anderson Cancer Center Madrid, on the occasion of the world commemoration day of the disease which held this September 5.
And although there is currently no cure for the disease, the development of new treatments in the field of immunotherapy is a great advance for patients. This is the case of the CAR-T therapy which targets the BCMA antigen, recently approved in Europe, indicated for the treatment of patients with relapsed or refractory multiple myeloma, who have received at least three previous therapies and have progressed in the last treatment.
In any case, autologous transplantation remains the standard treatment in patients with no comorbidities and with newly diagnosed myeloma. This treatment is carried out after the patient has received a few cycles of chemotherapy. "Patients who are not candidates for transplantation receive only chemotherapy treatment," she clarifies.
The use of treatment regimens based on the combination of four drugs that include the anti-CD38 monoclonal antibody in newly diagnosed patients, whether they are candidates for transplantation or not, has significantly improved the response rate and the quality of response and consequently, the rate of progression-free survival. In this sense, the use of immunomodulatory drugs (IMIDs) has also contributed as a maintenance treatment until progression.
Patient profile and early diagnosis
Nevertheless, regarding the general profile of the MM patient, Dr. Iglesias del Barrio points out that they are usually older patients, with an average age of around 65, although there is no standard patient profile since presentation is heterogeneous. There is usually a predominant symptom, which may be anemia, painful bone lesions that can cause pathological fractures or vertebral compression fractures, or even kidney failure that may require dialysis treatment.
She indicates that diagnosis is relatively straightforward, and that suspicion may be aroused by the results of a blood test. We will find a monoclonal peak in the proteinogram; that is, the presence of a protein that is an immunoglobulin, almost always of the IgG or IgA type. This monoclonal protein is produced by a clone of pathological plasma cells that are normally found infiltrating the bone marrow. For this reason, a bone marrow biopsy must be performed to allow us to quantify the degree of infiltration by plasma cells. With a percentage higher than 10% and the presence of the monoclonal component in serum and/or urine, the diagnosis is established. In addition, the study is completed with an imaging test allowing the entire body to be assessed in order to detect the presence of bone lesions.
COVID-19 and MM
In the last two years, we have had to adapt to the situation marked by the COVID-19 pandemic", explains the head of the Multiple Myeloma and Gammopathies Unit at MD Anderson Cancer Center Madrid, stating that initially they tried to prevent patients from going to hospitals in person, favoring the use of treatment plans based on oral drugs. In addition, she recalls that at the most difficult times the recruitment of new patients for clinical trials was limited and non-urgent transplants were delayed. In the case of hospitalized patients, we had to restrict the entry of companions.
However, she points out that they have had several cases of patients with myeloma in active treatment who have suffered severe SARS-Cov2 infection, of which more than half have overcome the virus without sequelae and have been able to continue with their corresponding cancer treatments. Finally, regarding vaccination, the doctor states that MD Anderson Madrid has recommended vaccinating patients with the vaccines provided by the Autonomous Region of Madrid (based on messenger RNA, or mRNA). Tolerance has generally been good, and we have not had to deal with serious complications.