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MGUS and Asymptomatic Multiple Myeloma (AMM)

///MGUS and Asymptomatic Multiple Myeloma (AMM)

Myeloma Patients Fare Better When Treated at Experienced Facilities

Feb. 9, 2017 | The UAMS Myeloma Institute, an international leader in myeloma research and clinical care since 1989, sees more myeloma patients than just about any other center in the world. The institute’s specialists treat myeloma day in and day out.  That is a distinct advantage for patients.  And, recent research indicating that patients fare better when treated at experienced medical facilities supports that advantage.

Findings from the Mayo Clinic in Rochester, Minnesota, show that people diagnosed with multiple myeloma are more likely to survive longer when treated at a medical center that sees lots of multiple myeloma patients. Published this past fall in the Journal of Clinical Oncology, “Association Between Treatment Facility Volume and Mortality of Patients With Multiple Myeloma” concludes that patients treated for multiple myeloma at facilities with high patient volume had a lower risk of death than those treated at facilities with lower patient volume.

The study, based on 94,722 patients treated at 1,333 facilities and adjusted for sociodemographic and geographic factors and comorbidities, noted some clear factors that play a role:

  • Most hematologists/oncologists in general practice see only two new and six established patients with multiple myeloma each year. It is difficult to be proficient with such a small caseload that comprises only 2% of one’s practice.
  • An unprecedented number of new drugs are becoming available for the treatment of multiple myeloma, and there is a wealth of new information about myeloma biology at the molecular level that is revealing targets for precision medicine approaches. Multiple myeloma is becoming increasingly complex to classify according to risk and to treat. A hematologist/oncologist in general practice cannot possibly stay current on everything pertaining to multiple myeloma while staying current on other, more common cancers.

“It is nice to have a study that validates what we have known for a long time,” said Gareth Morgan, M.D., Ph.D., director of the UAMS Myeloma Institute and professor of Internal Medicine in the College of Medicine. “Those of us who have devoted our careers to treating multiple myeloma understand that it takes a long-term, single-disease focus to truly appreciate the nuances of multiple myeloma and the factors that influence treatment choices for individual patients. We take this even further by integrating genetic studies with clinical findings to guide individual treatment plans.”

In addition to participating in international meetings where the latest clinical and research findings are shared among professional colleagues and staying abreast of peer-reviewed publications in the leading journals, Morgan and his team take advantage of the vast wealth of patient-related data that has been collected over decades at the Myeloma Institute. The data, which can be continually assessed as new, sophisticated analytical tools become available, reveal outcome patterns that shed light on which treatment methods are the most effective.

Another distinct advantage of centers that have had a high patient volume for many years is the presence of a well-oiled infrastructure. For example, other clinical services at UAMS, including nephrology, cardiology, hematopathology, radiology and orthopaedic surgery, have worked collaboratively with the multiple myeloma program and have built expertise in diagnosing and caring for the array of medical issues that can complicate treatment. Nursing staff in both the inpatient and outpatient settings also have specialized training that enables them to anticipate and quickly react to symptoms of the disease and treatment side effects and provide comprehensive care based on a keen understanding of the disease.

“Multiple myeloma is very complex,” said Faith Davies, M.D., the UAMS Myeloma Institute’s director of developmental therapeutics and professor of Internal Medicine in the College of Medicine. “A coordinated, multi-disciplinary team is essential for addressing the needs of patients and their loved ones. Having a large number of patients has helped drive an integrated, collaborative effort. In addition, community volunteers, as well as local hotels and restaurants, cater to our patients and are important components of our service that promote optimal outcomes. We are blessed to have such a wonderful community that goes out of its way to help our patients feel at home.”

As the Mayo study pointed out, substantial gaps in clinical outcome exist based on how many patients are treated.  If patients are able to come to a center like the UAMS Myeloma Institute, their chances of doing well are improved.

When multiple myeloma strikes, patients deserve to have options for getting the best care possible. The UAMS Myeloma Institute, with its almost 30-year history of pioneering and outstanding care that has attracted patients from across the globe and its expertise honed over years of caring for multitudes of patients, is committed to being the go-to center of choice and giving every patient the best chance for a long, disease-free life.

His Doctors Were Stumped. Then He Took Over.

Young Jewelry Designer Supports Myeloma Research

Photo by Christer Berg / Bailey McNeill’s raw crystal necklaces and bracelets bring joy to the wearer while also supporting myeloma research. McNeill donates half of her proceeds to the Myeloma Institute to help further development of curative therapies.

Feb. 10, 2017 | Bailey McNeill of Raleigh, North Carolina, is a UAMS Myeloma Institute rock star.

McNeill’s father was diagnosed with multiple myeloma at Duke University Hospital when she was in third grade. “He sat down with my sisters and me and explained that he would be traveling with my mom to a facility — apparently the best — in far-away Arkansas for more tests. It was the first time I ever saw him cry,” she said.

Now a freshman at the University of North Carolina at Chapel Hill, McNeill remembers the anger and sadness she felt in that moment. “It was not until I was older in high school that I learned more about his disease and how special it is that he is still with us, thanks to the doctors at the Myeloma Institute,” she said.

It was also during her high school years that McNeill honed a hobby that would ultimately make a difference for others living with multiple myeloma, a cancer of plasma cells in the blood.

“I got interested in making jewelry when I saw companies like Free People or Urban Outfitters selling raw crystal jewelry. I had hundreds of crystals just sitting around, and I knew I could make similar pieces,” said McNeill, who has always had an eye for crystals and sparkling rocks.

She started out making holiday gifts for family members. Then, inspired by her father’s myeloma journey, she developed her talent into an online business, Crystals4Cancer.com. Her one-of-a-kind necklaces and bracelets bring joy to the wearer while also supporting myeloma research – McNeill donates half of her proceeds to the Myeloma Institute to help further development of curative therapies.

McNeill knew that she wanted her hard work and time to amount to more than just a profit. “I pretty much built my business around donating to UAMS,” she said. To date, McNeill has donated $5,645.

McNeill’s exclusive source for her gems is Randall Glen, located about 15 minutes outside of Asheville, North Carolina. The mine offers “dig your own buckets” at various price points, depending on the size of the stones. A $10 bucket typically contains small stones like garnets and amethysts that are abundant in the North Carolina mountains. Larger buckets, that can cost as much as $150, contain larger, flashier gems.

While in high school, McNeill would often spend 40 or more hours each week on her jewelry business, producing 80 to 200 pieces each year. Now that she is in college, it’s more like 20 hours. With a major in global studies and a likely minor in entrepreneurship, her free time is limited.

“It has been hard to make and get out a bunch of orders since I’ve come to school. If I don’t have as much time to take photos of my pieces, then I promote them less on social media, resulting in less demand and orders. It’s a lot to keep up with,” she said.

McNeill continues to be encouraged and inspired by her dad. He comes to UAMS twice a year for check-ups and is on an active treatment regimen. “He handles it like a champ and is always upbeat,” she said, adding that he remains involved in his work, a wholesale produce business founded by McNeill’s great grandfather.

“Though my contribution is small, I hope my business is helping the program that has done so much to help my family and me; it’s the least I can do,” she said.

From the Director

Gareth Morgan, M.D., Ph.DDear Readers,

I am pleased to share with you my excitement about discoveries in myeloma biology that are unfolding at a rapid rate and raising the bar for effective, precision treatment.

As you will learn in this issue of Myeloma, a collaborative international study has revealed gene variants that increase the risk of developing myeloma. These findings have given us new insights into the biological mechanisms of myeloma development and are helping us craft strategies for myeloma prevention.

Additionally, our talented research team is mining and integrating large data sets in order to zero in on the subtleties involved in molecular relationships and processes that support myeloma growth.

While our laboratories are busy with novel scientific investigation and our bioinformatics experts are analyzing “big data,” our clinicians are focused on delivering comprehensive patient care with compassion, expertise and overall excellence. It is the partnership between our sophisticated research and clinical components that gives us an edge in making a cure a reality.

We look to our supporters to help us maintain the momentum of our cutting-edge research and clinical care. The generosity of so many donors who believe in our program makes it possible for us to advance curative treatments and bring promise to patients worldwide.

In the spirit of the holiday season, I hope you will respond to our annual appeal in this issue of Myeloma and help us make the future brighter for patients and their families. My thanks and gratitude in advance.

Cheers and kind regards,

Gareth Morgan, M.D., Ph.D
Director, UAMS Myeloma Institute

From the Editor

Janet AronsonThe development of personalized medicine approaches to treating myeloma and related diseases takes center stage in this issue of Myeloma. With a wealth of patient sample-derived data, sophisticated systems for analyzing the data, and talented experts who can interpret the analyzed data, the Myeloma Institute is making significant progress in the understanding of myeloma biology at the molecular level. This enables our translational research team to get better answers to questions related to diagnosis and treatment and maximize the potential for improved health.

Making a difference in the lives of patients and their loved ones is what makes the Myeloma Institute tick. It is the basis of our focus and drive, and it is exemplified by our patients’ stories. We hope all patients have access to care that is informed by advances in personalized medicine approaches and that offers a new lease on life. We welcome your comments. Feel free to contact us via email.

Sincerely,

Janet Aronson
Editor
AronsonJanetL@uams.edu

Big Data Analysis Fuels Personalized Medicine

A truly unique feature of the Myeloma Institute is its wealth of patient-derived clinical and research data. With more than 11,750 patients over a period of 27 years, the Myeloma Institute has amassed a treasure trove of data elements, many at the molecular level, that have the potential to yield new understandings of disease biology and response to treatment. Data from current patients is continually added to the collection. Additionally, the Myeloma Institute’s large tissue specimen archive presents the opportunity to mine even more data, utilizing today’s sophisticated analytics tools.

A single patient can generate a lot of meaningful pieces of data — up to 100,000 — based on information gleaned from the 20,000 to 30,000 genes in the human genome. Data are derived from patient samples that are subjected to DNA sequencing, gene expression profiling, and proteomics expression studies and are annotated with various patient information such as age, sex and disease state.

Multiplying so much data by thousands of patients results in “Big Data.” Big Data implies large volume and complexity, such that advanced mathematics and large, high-performance computers are needed. Big Data requires very big computers, massive amounts of storage, and sophisticated mathematics.

Computational biology, also known as bioinformatics, is the field of using computer-based analysis and statistics to understand biology. It covers both basic research (in the laboratory) and translational research (developing clinical applications from basic research), and spans the full spectrum from molecules to human population studies. Computational biology/bioinformatics is a subset of Biomedical Informatics (BMI).

BMI is focused on the management of large data sets in health care. It is a means of organizing and understanding data and turning it into knowledge, with the overarching goal of improving human health, and is an integral part of the search for disease-associated genes. An interdisciplinary field, BMI involves the development, study and application of theories, methods and processes for the generation, storage, retrieval, use and sharing of biomedical data. It encompasses the utilization of existing computational and statistical methods and algorithms, as well as the development of new methods to extract knowledge from the underlying data and advanced decision support systems to improve clinical practice. BMI is integral across the whole spectrum from molecules to populations, bridging basic and clinical research and practice.

At the Myeloma Institute, we are striving to better understand the intricate network of molecular processes involved in myeloma. The vast amounts of molecular and clinical data that we have amassed via genome sequencing and other high-throughput techniques (large-scale methods to purify, identify and characterize DNA, RNA, proteins and other molecules) contain crucial information with the potential of leading to development of more effective, targeted therapies. We are mining and integrating these data, and resolving the subtleties involved in the pathways and molecular relationships that support myeloma growth. By identifying molecular patterns that characterize each individual genome and discerning which of these individual variations is related to a disease subset or response to treatment, we can further the development of tools for diagnosis, prognosis and personalized treatment.

We do this, in part, through the identification of disease-related SNPs (single nucleotide polymorphisms) derived from large-scale techniques. Mutations in the genomic code often produce changes in the protein sequence, leading to diseases. The key to approaches that identify disease mutations lies in distinguishing between SNPs that are functionally relevant from those that are not.

Christopher Wardell, Ph.D., an experienced bioinformatician with particular expertise in next-generation sequencing, joined the Myeloma Institute in July. Educated and trained in the UK, Wardell was a lead bioinformatician at The Institute of Cancer Research in the UK and a research scientist with the Laboratory for Genome Sequencing Analysis at the RIKEN Center for Integrative Medical Sciences in Japan.

“We are aiming to spot the differences — to see what makes a normal cell become cancerous,” Wardell said. “By comparing the normal genome of a patient to the genome of their tumor, we can identify the DNA changes that predispose and cause someone to develop cancer.”

The ultimate goal is personalized medicine. “We can sequence a person and their cancer and then target treatment to the mutation or signaling pathway that is out of kilter,” Wardell said. “We can get better answers to questions of diagnosis and treatment.”

The more complicated the question, the more samples that are needed. Similarly, to determine how frequently a certain gene is mutated, high- resolution technology is essential.

In terms of sample quantity, the Myeloma Institute is unsurpassed. “We have one of the largest repositories of myeloma specimen samples in the world. Using today’s modern tools, we can take current data, compare it with data in the repository, and use this information to direct future research and treatment strategies. This puts us in a distinctive position,” Wardell said.

Having so much data enables drill-down to a very detailed level of information. Given the volume of data, the process is time consuming.

“But, processes that have been slow in the past are speeding up. Computational speed and capacity doubles every 18 months,” Wardell said.

Recognizing the importance of bioinformatics for developing curative therapies, the Myeloma Institute has a dedicated team of five specialists, including Wardell, who is the team leader. They are part of the first generation of full-time bioinformaticians, and they are poised to help the Myeloma Institute reach new heights in the development of curative therapies.

“What makes us tick is reaching the clinic, feeling like you are making a difference,” Wardell said.

While Wardell and two of his faculty colleagues are focused on the Myeloma Institute, their academic appointments are in the Department of Biomedical Informatics, established at UAMS one year ago. The department, directed by Fred Prior, Ph.D., develops computational tools to assess and manage medical and public health information and leverages data and maximizes its potential for improving health and health care.

Prior is the principal investigator for The Cancer Imaging Archive (TCIA). Supported by the National Cancer Institute, the TCIA provides researchers, educators and the general public with a vast, freely accessible, open archive of cancer-specific medical images and metadata (http://www.cancerimagingarchive.net/). TCIA is a service that de-identifies and hosts a large archive of medical images of cancer accessible for public download. The data are organized as “Collections,” typically patients related by a common disease (e.g. lung cancer), image modality (MRI, CT, etc.) or research focus. Prior’s group is in the process of hosting radiology images, including PET and CT scans, and gene expression data from the Myeloma Institute on TCIA.

Both the Department of Biomedical Informatics and TCIA are valuable resources to the Myeloma Institute that help ensure that Wardell and his team have access to sophisticated, state-of-the art technology, information and processes. This, in turn, translates into expanded understanding of cancer biology that will speed the development of precision medicine approaches to curing myeloma and related diseases.

Sources:

American Medical Informatics Association,
www.amia.org

Kann, Maricel G: Advances in translational bioinformatics: computational approaches for the hunting of disease genes. Brief Bioinform. 2010 Jan; 11(1): 96-110. PMID: 20007728