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Relapsed / Refractory Multiple Myeloma

///Relapsed / Refractory Multiple Myeloma

Multiple Myeloma Research Foundation (MMRF) Announces $4 Million Investment from the Perelman Family Foundation to Launch MMRF Prevention Project

Climb and Punishment–Uphill, Roadkill, and More.

The elevation is one of the harder aspects of taking on a long bike ride. Although you may think the state of Arkansas is flat because of the Mississippi Delta region that makes up the southeast portion of it, I’m here to tell you that is certainly not the case.   The Big Dam Bridge 100 cycling course has a total ascent of 4840 feet, with the worst headache coming right around mile 65, where there is this massive hill with an elevation that peaks at about 815 feet.

So, I know what you are ‘supposed’ to do when it comes to training to improve your climbing ability.  It’s all about the power-to-weight ratio.  In other words, to be in top climbing shape, you need to weigh roughly twice in pounds what your height is in inches.  So if you are, let’s say, 5’10 (70 inches) you should weigh in at a whopping 140lbs. Seeing as how I’m not going to be one of those Tour de France guys breezing through the mountains of the Pyrenees, singing “Ain’t No Mountain High Enough,” I’ll skip the lettuce-only diet and stick to what works—ice cream.

Another thing to do is to try and stay seated most of the way up.  It uses less energy than coming off of the saddle, and with 30 plus miles remaining, that is important.  Of course by mile 65, staying seated is difficult when that part of your body you desperately try to ignore occupies your entire existence… When you can no longer appreciate the sweet smell of sweat and burnt rubber on the beautiful path of victory because all you can think about is that bloody pain in your rear.

While staying hydrated is really important– especially during the Arkansas heat– taking in too many liquids will cause you to make multiple stops to answer the call of nature.

Managing your caloric intake is also crucial for a 100-mile ride, so it is important to keep eating along the way.  It will definitely help you feel a lot better at the end of the race.

As I was riding at about the 30th mile, I started thinking about all the dangerous encounters one might face while cycling the trails in Arkansas.  From the snakes to the big trucks, the open road can be a hazardous place, especially if you aren’t in a car.  This is evident by the volume of carcasses spotted on the roads. I mostly see armadillos (like today), but there are also many other species out there.  There is roadkill everywhere!

Let’s not forget the mosquitoes… Oh, and the ever-present multitude of gnarly gnats that get in your eyes, up your nose, and in your mouth.  The gnat splats on my forehead are a real badge of honor.

Then, of course, there’s the fluctuation in weather, which I was lucky enough to encounter today.  It began with beautiful sunshine, and I didn’t have a care in the world. The next thing I know I was surrounded by mammoth dark clouds with grumblings of thunder in the distance. I thought to myself that this was not going to work out well.

And it didn’t. It was a complete disaster. I was prepared for the heat and dehydration, but what I got was thunder, lightning, and more water than I could imagine with the torrential downpour of rain. I guess you can never be too prepared.  If it looks sunny, you better pack a rain suit.

Water Break dead animal road with a storm rocks and river

Fuel my Ride–Ice Cream Please!

Dr. Morgan with road bikeCycling is awesome and truly invigorating.  It’s a quick way to get about, take in the fresh air, and appreciate the environment surrounding you.

But riding around enjoying the scenery does little to prepare you for the demands of an intense race.  At some level, I thought this “old man strength” phenomenon might kick it into gear for me.  You know what I’m talking about…like one of those burly old dudes, you see at the gym who somehow manages to defy gravity by bench-pressing  5 times his bodyweight like some sort of geriatric He-Man.   And why do they always wear these pants that clearly have been shrunk in the dryer?  I’m told these are real and not some sort of laundry mishap.  Skinny pants? No thanks.

Anyway, for me, ramping up slowly to build endurance through longer and longer rides are the most practical approach to taking on this challenge. Plus, it’s nice to have someone training alongside you for encouragement (and if you take a little spill).

So, off we go.

Did I mention that ice cream is a crucial part of my training?

Cycling requires an intense amount of energy, and the body needs help to keep it at its optimal performance level.  If you don’t refuel, you will learn that it isn’t long before you encounter the dreaded “bonk.”  For you non-cycling enthusiasts, it means hitting the wall, r experiencing a complete loss of energy and your legs feel like cement.

Besides, I would rather do anything than train for hours without some sort of self-gratification. And the more miles you ride, the better the ice cream tastes. So, with this in mind, Sunday’s training involved a stop at the local ice cream shop in the downtown River Market district area.  It’s quite a fun place with good food, alcohol, and above all else, my favorite chocolate ice cream. The store windows also provide an opportunity to check yourself out—you know…taking a quick glance to see what you look like when you ride.

Ice Cream downtownThere’s my bike in the picture… and some bald guy who happens to be walking by. He was trying to check himself out in the window but turned away when he saw us taking photos.  Anyway, getting a dish of ice cream is a stroke of genius.

After the stop, we headed off again.  We traveled over into the North Little Rock side of the river. It is very pretty riding through the nature park which forms a major part of the Clinton library area.  It is a great place to hang out, relax, and look for birds and snappers.  You can see the river and the river trail as it leads into the downtown area. We took some great pictures.

So, I am pleased to say that today’s training went very well.  As they say, those who train (and eat ice cream) together remain together.  Cheers.

This is Dr. Davies at the start of the Big Dam Bridge which leads to the Clinton library.  It’s a beautiful day that is perfect for a few hours of hard training.

Big Dam Bridge Little Rock

Multiple myeloma treatment advances: What health execs should know

Multiple myeloma is a rare cancer, representing about 1.8% of all cancers combined, according to the National Cancer Institute. About 30,000 new cases are expected in the U.S. in 2017. It is more common in men than women, among individuals of African-American descent, and those aged 65 years and older. The SEER Cancer Statistics Review, a report of the most recent cancer incidence, mortality, su

Multiple myeloma is a rare cancer, representing about 1.8% of all cancers combined, according to the National Cancer Institute. About 30,000 new cases are expected in the U.S. in 2017. It is more common in men than women, among individuals of African-American descent, and those aged 65 years and older. The SEER Cancer Statistics Review, a report of the most recent cancer incidence, mortality, survival, prevalence, and lifetime risk statistics published annually by the Surveillance Research Program of the National Cancer Institute, notes that the five-year survival rate of myeloma is 49.6%.

It has been an exciting time at the Myeloma Institute at the University of Arkansas for Medical Sciences (UAMS), in Little Rock, Arkansas, on all fronts, namely, embarking on research that could play an important role in the development of preventative and curative strategies for multiple myeloma in the future.

“We continue to see a large number of patients with multiple myeloma and other plasma cell disorders from across the United States and the world,” says Gareth Morgan, MD, a physician and director of the Myeloma Institute. “Our research investigations have led to some exciting discoveries in the biology of myeloma based on the genetic variations within the human genome. With our colleagues in Europe, we have identified eight new genetic variations that could be linked to an increased risk of developing myeloma.”

UAMS is focused on developing a molecular classification of patient subgroups with distinct pathogenesis and clinical behavior. It partnered with Celgene and the Dana–Farber Cancer Institute in establishing a global collaboration called the Myeloma Genome Project.

“The goal of this project is to compile and analyze the largest set of genomic and clinical data to design a molecular classification system to improve the diagnosis, prognosis and treatment of myeloma,” Morgan says. “This initiative could really lead the way in developing targeted treatments for patients in the future.”

Morgan recently spoke with Managed Healthcare Executive (MHE) about other promising developments in the multiple myeloma field, as well as the challenges and ways to overcome them.

MHE: What are healthcare executives’ major challenges in the area of multiple myeloma?

MorganMorgan: Uncertainty about the future of healthcare policy and payer coverage is clearly one of the biggest challenges faced by leaders across the industry. We know that patients diagnosed with a complex cancer like myeloma fare better when they are treated by a specialist at an experienced facility like the UAMS Myeloma Institute, when compared to oncologists in community-practice settings for whom myeloma may only represent a small portion of their patient population.  Unfortunately, some patients don’t have access to specialized myeloma programs because of insurance or other financial restrictions. This is something we see every day.

The personal and economic burden of a cancer diagnosis like myeloma really heightens the urgency for more research, but decreases in federal and state funding have made it more difficult.

MHE: How can these challenges be met or avoided?

Morgan: Maintaining the quality of clinical care and sustaining our research program are our highest priorities. We are not implementing cost reduction strategies but rather are discovering more effective ways to improve outcomes by addressing variations in practice and optimizing resources through a service-line approach. We are also expanding our collaborations with university and industry partners to develop new clinical trials to answer strategic questions related to high-risk disease. We are also working on improving the myeloma clinical guidelines through the International Myeloma Working Group.

MHE: What are promising developments in multiple myeloma?

Morgan: The increased understanding of the genetics and epigenetics involved in the initiation and development of myeloma cells has really powered the concept of precision medicine, such as the development of targeted therapies directed at specific mutations at the molecular level.

Immunotherapy represents another promising treatment approach for patients.  Addressing relapsed disease via resistant clones has led to the development of new immune-based strategies, some which are already approved and providing results and others which are in development.

An exciting advancement on the horizon is the development of a peripheral blood biopsy as an alternative to bone marrow aspirate and biopsy, which not only would be more comfortable and convenient for patients, but may also offer a more comprehensive profile of myeloma cells, which could be of particular use in the earlier stages of the disease, such as in pMonoclonal gammopathy of undetermined significance]  and smoldering myeloma.

Original story:
http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/multiple-myeloma-treatment-advances-what-health-execs-should-know?page=0,0

My First Big Dam Post

Gareth Morgan, MD, FRCP, FRCPath, Ph.D.So, first I would like to say that bicycling is a great joy in my life, but I find that I really cannot tell you that.  I am aging, and it is killing my body.  Nonetheless, let’s get this blog thing going.

Besides being a middle-aged Welsh myeloma doctor from London, now living for almost three years in Little Rock (please no overused sheep jokes), I have been cycling for about five years.  I used to run, but now I am old and arthritic.  And I like to wear spandex.

So, this year I’ve decided to ride in the Big Dam Bridge 100 in September—the full 100 miles.  It will be good for me. The training is challenging, but finishing the ride is well worth it.  It’s similar to what patients go through when they undergo chemotherapy or other treatment.  It can be difficult, but having a good team, good equipment, and a good attitude makes all the difference.

We’ve formed a team here at the Myeloma Institute, and Faith (Dr. Davies), Brian, and others have joined me in training for the 100 miles.   We hope that by riding as a team for our patients, we can increase awareness about myeloma in the community and raise funding to support our research at the Myeloma Institute.

It should be quite awesome actually.  Seriously.  So whether you would like to join me this year on the 100-mile ride, or just want to check out what all the bike hype is about, you should sign up and plan on joining us.  There is a 10-mile route for the beginners, and there are other routes ranging up to the 100-mile motherload that I like to think of as my Tour de France. Well, that’s it for now. I’m hungry and plan to have curry.

Cheers!
Gareth Morgan, MD.

Honors for Man & Woman for fighting blood cancer

Nadine Baxter, president of the Leukemia & Lymphoma Society board, lost her mother to acute myeloblastic leukemia within three days of her diagnosis in 2013. Baxter is gearing up for the society’s Man & Woman of the Year Grand Finale Celebration, to be held Friday.

Nadine Baxter, president of the Leukemia & Lymphoma Society board, lost her mother to acute myeloblastic leukemia within three days of her diagnosis in 2013. Baxter is gearing up for the society’s Man & Woman of the Year Grand Finale Celebration, to be held Friday.

Nadine Baxter has spent the last 17 of her 40 years as a nurse practitioner working with blood-cancer patients, specifically those with myeloma.

Four years ago, blood cancer hit home. Hard and fast.

“My mother developed a cough, and we didn’t know what the problem was,” Baxter recalls. She took her to a pulmonologist, and her mother had perfect lab results. That was Valentine’s Day 2013. Another round of tests less than a month later showed she was anemic.

Baxter’s mother was diagnosed with acute myeloblastic leukemia, and died within three days of her diagnosis. “Being a nurse in the middle of it, and taking care of so many patients — it was very difficult for me,” Baxter says.

Shortly thereafter, Baxter was presented with a chance to keep her mother’s legacy alive. Her daughter, Devin Henson, found out about Light the Night, a fall fundraising walk for the Leukemia & Lymphoma Society. Henson asked Baxter if she thought the event would be “a good way to honor Nana.” Baxter agreed that it would be.

Then Baxter met Kim DuPas, manager of the society’s Arkansas division, which opened the door to participation in another society-sponsored event — the Man & Woman of the Year. Baxter captured the title in 2015 and has been involved with Man & Woman of the Year ever since.

The competition’s 2017 Grand Finale Celebration is set for Friday at the Embassy Suites Little Rock. Candidates are Jill Avery with Central Arkansas Veterans Healthcare System; Dow Brantley of Brantley Farming Co.; Jennifer Fitzgerald; Mike Mueller of P. Allen Smith Cos.; Charles Robbins of Data­Path Inc.; Angela Stewart of the Eleanor Mann School of Nursing at the University of Arkansas, Fayetteville and Highlands Oncology Group; and Justin Thomas, a student at the University of Arkansas at Pine Bluff.

Man & Woman of the Year is a national program for the society, taking its fourth turn in Arkansas. Baxter, who raised more than $40,000 the year she won, is now the society’s board president. This year she will be presented the organization’s Legacy Award for “just making a huge footprint for a cure here in Arkansas,” DuPas says.

Blood cancers are the number three cancer killer, according to society information. About 1.2 million people in the United States are living with blood cancer or are in remission from it. All the money raised by the Arkansas division stays in state to provide financial aid to cancer patients who must travel long distances for treatment and need help paying for gasoline, or need insurance assistance. The society also provides group support for these patients.

“A large portion of our money that we raise goes toward research,” DuPas adds. “Our main goal is to find a cure.”

Nominations are taken from all over Arkansas.

“We look for leaders in the community who have been touched by blood cancer and have the capacity to get out there and go through their network and really just give back,” DuPas says. These include cancer patients, health-care professionals who have worked with them or people who have friends or loved ones affected by cancer. They are given 10 weeks to raise money via sponsorships, donation solicitations and hosting fundraising sales and events.

“They truly are all winners. They are all one team working toward a goal,” DuPas says.

In her volunteer capacity with the society, Baxter helps to find Man & Woman of the Year candidates. She has worked to get T-shirts for a candidate, hosted meetings, donated food for a fundraising bake sale and solicited auction items.

“We should pay her,” DuPas says. “It truly would not be what it is today without Nadine.”

The 2017 finale will also include a special appeal featuring the Inspirational Boy and Girl of the Year — young patients who share their stories and motivate candidates throughout the fund drive. This year’s Boy and Girl are Will, who has survived non-Hodgkin’s T-cell lymphoma and acute myeloblastic leukemia; and Addison, an acute lymphoblastic leukemia survivor. The children will go into the audience to pick up donations.

“It’s hard to say no to them,” DuPas says.

The finale celebration — offering silent and live auctions, a dinner program presenting the candidates/winners and a donation drive — was first held at the Clinton Presidential Center but outgrew the space. The proceeds increased, too. Its first year, the society raised around $80,000. Fast forward to 2016, when event proceeds amounted to about $202,000. More than $460,000 has been raised since its inception.

The goal for this year’s campaign is $240,000. Baxter’s dream for the event would be “no less than 20 candidates, and no less than half a million dollars.”

She likes to see patients get immediate aid with the event proceeds.

“People don’t realize that it’s hard — when you have one of these catastrophic disease processes going on — to make ends meet, even if you do have a great deal of money. I’ve said a lot of times we could bankrupt the richest person in the world because it’s so costly.” The society has a $10,000 allotment per year that they’ll give to patients to help them pay their insurance premiums or make co-payments.

But there’s the big picture, too, Baxter adds. “That research is so very vital so that we can completely do away with blood cancers. If I’m unemployed, it’d be fine.”

The Leukemia & Lymphoma Society 2017 Man & Woman of the Year Grand Finale Celebration begins at 6 p.m. Friday. Tickets are $100 and are available by contacting Kim DuPas at kim.dupas@lls.org or (501) 227-6416.

High Profile on 04/16/2017