In 2013 we called on myeloma expert Dr Andy Chantry to answer your questions about myeloma as part of our Myeloma Awareness Week 2013 coverage in support of Myeloma UK. As a leading researcher in the development of myeloma treatments at the University of Sheffield’s Medical School and a practicing clinician at Sheffield’s Royal Hallamshire Hospital, Dr Chantry answered questions on a wide of topics from queries about symptoms to pain control for those in the latter stages of the cancer.
Here's the Q&A in full:
'Is there any better way of controlling the pain in the latter stages of the cancer?”
- Jane Carter via Facebook
Dr Chantry: "We are developing better pain treatments all the time now partly because we recognised how poorly this has been done in the past. This will be helped by good communication between the patients and the doctors in order to get the most powerful pain killers prescribed but also we are looking at totally different kinds of pain killers to better control bone pain. We are currently planning mouse experiments to help determine the most effective strategies."
'Can basal cell carsonoma turn into other cancers like myeloma?'
- Vivan Werts via Facebook
Dr Chantry: "No. This is a totally separate skin cancer. Myeloma is often confused with melanoma which is another, very aggressive skin cancer which requires immediate attention. If in doubt about any funny looking mole that appears, especially a mole that rapidly changes in appearance, consult your GP quickly!"
'I’m moving to Sheffield in September to study medicine and have been reading about your amazing research, Andy, and would like to know what the advantages and disadvantages are of combining both practicing medicine and carrying out research.’
- Kayleigh Smith via email:
Dr Chantry: 'Combining research and clinical practice is a brilliant combination. There are no disadvantages! As a clinician, I care for patients, attend to their needs, prescribe complex and simple therapies and hear their stories. It is for them that we do the research! They tell us what we need to be working on eg finding a cure for myeloma(!) and also which aspects of the disease really matter for patients. I have a great set of clinical colleagues and a great team of researchers and we are determined to beat this blood cancer! Get in touch when you arrive in Sheffield!'
‘What new developments for treating the disease are you excited about?’
- Lauren Smith via Facebook
Dr Chantry: "I am really excited about our bone strengthening drugs for myeloma! Existing treatments can slow down the damage to bone but do not repair bone that is already damaged. There is a desperate need to do this and we have developed at least three compounds that appear to do just that! We are just confirming our results but will then need to work with the pharmaceutical industry to get these promising agents manufactured and out there to patients. There is also some promising evidence to suggest that these agents may also have an anti tumour effect which would be amazing if confirmed! I am also really excited about some other drugs that we are working on that target hidden myeloma cancer cells. If we could 'search and destroy' these cells, curing myeloma once and for all becomes a real possibility!"
'Why is myeloma more common in older people? Can children develop myeloma?’
- Andy Jackson via Facebook
Dr Chantry: "The average age of diagnosis is 70 years old. 15% of patients are less than 60 yrs old and only 2% less than 40 years old. Myeloma is extremely rare in younger people. We do not really fully understand why this is. Myeloma is a cancer in which the normal immune responses of white blood cells is hijacked. As we get older these normal body responses become more fragile and prone to going wrong so to that extent, as we age, our repair mechanisms become less effective, our bodily functions including the immune responses of white blood cells, become more fragile and cancers like myeloma become more common."
'What is the best way to raise awareness of myeloma? Are there any early onset signs to look out for?'
- Nick Smith via Facebook
Dr Chantry: "Just keep telling everyone about it! Especially your GP, who will have heard of it but may have forgotten about it! MyelomaUK is running an awareness programme with GPs to flag up early warning signs which include new onset back pain or pain in other limbs, recurrent infections, rapid onset of tiredness and malaise. Doctors should check full blood count, ESR and serum and urinary electrophoresis to look for the characteristic myeloma antibody paraprotein (also called monoclone or mspike). We are enormously grateful to Leukaemia and lymphoma Research who fund our work and are really excited about the future. New treatments are coming online all the time for this disease including a number of agents we are developing in Sheffield made possible by generous donations and LLR! Thank you! Together, we CAN beat this disease!"
‘I’m thinking about switching from normal blood donation to plasma donations. Is this something that could be used in myeloma treatments?’
- Siobhan Davis via Facebook
Dr Chantry: "We have a desperate need for donors of all blood products! Plasma is used in the treatment of myeloma and is a scarce and precious resource. Please do consider donating everyone, but particularly if you are a member of an ethnic minority in whom there is a particular shortage of blood products! Thank you!"
'Why is the treatment of myeloma less successful than other types of blood cancer?"
- Andy Jackson via Twitter
Dr Chantry: "Myeloma is usually at least partially responsive to therapy. But we think that residual myeloma cells hide in protective niches deep within the bone marrow. We are urgently tracking these cells down and trying to find out what keeps them hidden, how they disguise themselves, how they anchor themselves into these nooks and crannies and how we can break those bonds and destroy these residual cells. There is real progress on this front and we are adopting a number of novel strategies to do this. For example, we are adopting a Trojan Horse strategy whereby we use cells called macrophages, which naturally travel to areas adjacent to cancer cells and use them to carry a virus which replicates on encountering myeloma cells and kills the myeloma cells only leaving healthy tissue unaffected. This, and similar approaches really has the potential to once and for all destroy all myeloma cells and lead to long term cures. We have to make this happen! And with your support, and the support of LLR we will do our absolute best to make this happen!"
‘Is it true that myeloma is more common in men than women?’
- Karen Walker via Facebook
Dr Chantry: "No, I don't think so. Equal distribution between the genders. More or less."
'What are the common symptoms/effects of myeloma? What is the usual treatment for the cancer?’
- Katy Jackson via Facebook
Dr Chantry: "Dear Katy, The common symptoms of myeloma are new onset of back pain, an unexpected broken bone often coming out of the blue when doing something quite normal like shopping or gardening; tiredness that comes on really quite quickly may be a sign that you are anaemic and there may be a blood cancer like myeloma driving this; repeated infections over and above what one might expect is a possible sign that something is not right; high calcium in the blood can cause confusion and kidney failure caused by myeloma may make you feel very sick, stop passing urine and even go a very sallow colour. If in doubt, go to your GP and ask him or her to do a full blood count, kidney function tests, measure calcium, ask for x-rays and do a test called serum and urinary electrophoresis. Tell the GP 'I think I may have myeloma' and they will act accordingly.
The usual treatment for myeloma is a combination of three oral chemotherapies - cyclophosphamide, usually taken once a week, thalidomide or related drugs taken at night because it can cause you to become drowsy and dexamethasone - a steroid often taken in four day blocks. Patients also receive supportive medication including bone protecting drugs called bisphosphonates, often administered as a monthly infusion via a Haematology Day Ward, anti sickness drugs, pain killers and drugs that protect the lining to the stomach and gut. Antibiotics are used where required. An excellent website to check out is myelomaUK.co.uk for info on the treatment of myeloma. We try whenever possible to treat myeloma at home but have a low threshold for admission if patients become unwell. Close communication with clinical nurse specialists (angels!) and the Haematology Ward is essential! Younger patients are offered autologous (meaning from yourself!) stem cell transplants which are effective treatments in myeloma and buy you much more time. New treatments are coming out all the time including drugs related to bortezomib or Velcade, a common second line therapy. It is a very exciting time to be working on myeloma and survival is increasing and increasing but we will not stop until we have beaten this blood cancer for good!"
Dr Chantry and his team at Sheffield have developed a drug that prevents bone damage, and is also being tested in clinical trials.
Got a question about myeloma?
Earlier on this year, we updated our booklet on multiple myeloma to include the most up to date information on treatments, which you can view, download or order from us for free. You may also like to contact someone in our Patient Information team on 020 7685 1051 or by email at firstname.lastname@example.org