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?
Morgan: 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.
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.
Gareth Morgan, MD.
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 firstname.lastname@example.org or (501) 227-6416.
High Profile on 04/16/2017
Clues to be found in more personalized treatment for multiple myeloma can be found in the genetics of myeloma in each individual patient. Dr. Gareth Morgan and the UAMS Myeloma Institute in collaboration with the Dana Farber Cancer Institute and other institutions are working to collect genomic data from myeloma patients with the goal of segmenting patients into groups that could lead to more personalized therapy. Learn more about why this matters to you as a myeloma patient and how you can weigh in to help researchers come to conclusions faster. Listen Now