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MIOT MYELOMA CONCLAVE 2019
Myeloma is no longer the point of no return.
MIOT International has organized MIOT MYELOMA CONCLAVE 2019 on 10th October. It is an enlightening conclave that focused on developments that have been breaking new ground over the last 5 years when it comes to treating myeloma, which is a blood cancer arising from plasma cells.
There was a time when the condition used to be rarely diagnosed in India, mainly due to lack of awareness in the medical fraternity. Few orthopaedic specialists and nephrologists would have picked up myeloma in their patients. Although there is an increase in the number of myeloma cases being presented to Haematology / Bone Marrow Transplant (BMT) units today, there is still the urgent need to spread awareness on a larger scale.
MIOT MYELOMA CONCLAVE 2019 was proud to host Dr. Vincent Rajkumar from Mayo Clinic (a leading hospital in the US) as the keynote speaker. His expertise in myeloma is matched by very few in the world. With such distinguished presence for company, the conclave has enlightened doctors and other members from the medical fraternity who participated in this conclave.
Photograph seen from left to right: Dr. Chezhian Subash, HOD, Haematology, Haemato-Oncology and Bone Marrow Transplant MIOT International, Chennai, Mrs. Mallika Mohandas, Chairman, MIOT International, Chennai, Dr. Kishore Kumar, Haematologist and Bone Marrow Transplant Physician, MIOT International, Chennai, Prof. Vincent Rajkumar, Professor of Medicine and Haemato-Oncology, Mayo Clinic, Rochester.
WHAT IS MYELOMA?
Myeloma is a type of blood cancer that develops in the bone marrow. The bone marrow is home to various type of cells like red blood cells, neutrophils, lymphocytes, plasma cells and platelets. Plasma cells are a type of white blood cells that help antibodies fight infections. When their natural way of functioning gets affected, there will be an unregulated production of plasma cells. A cancerous plasma cell is called a myeloma cell. Myeloma is also referred to as “Multiple Myeloma” because in most cases there are multiple patches or areas in the bone where it grows.
STATS THAT MATTER
Myeloma is the 2nd most common blood cancer in the world. Men are 1.5 times more likely than women to develop multiple myeloma. While the disease is most frequently diagnosed in 65-74-year-olds, it is not uncommon among younger people these days. Overall, two patients for every 150,000 turn up with myeloma. It adds up to 20,000 new myeloma cases every year in India.
HOW IT AFFECTS THE BODY
The composition of plasma cells is around 5% in the bone marrow. If cancer occurs in these plasma cells, it will start spreading in the bone marrow.
- Once the plasma cells growth reaches a critical threshold, they will start occupying more space in the bone marrow and prevent the growth of normal cells, thereby resulting in low blood count
- Also to make space for the multiplying plasma cells in bone marrow, they erode the bone. This will release calcium from bones and make calcium levels in blood to go high sometimes causing life threatening complications like seizures. Due to bone erosion, patients have severe back pain and bone fractures resulting from trivial injuries.
- Normal plasma cells secrete globulin to provide immunity. As plasma cells multiply uncontrollably in case of cancer, the globulin level in the blood increases. When it gets deposited in the kidney, there is a chance of kidney failure.
This is why most of the Myeloma patients first see an orthopaedic specialist (for fracture, pain) or Nephrologist (kidney related problems) rather than consulting a Haematologist.
MYELOMA SYMPTOMS
- Long standing low back pain in a patient above 50 years of age
- Low blood count (especially anemia) which makes the patient unresponsive to supplements or balanced diet
- Repeated chest infections more than two times within three months or more than six times in the last year
- Weakness of lower limbs and poor control of bladder / bowel with back pain
WIDELY USED TREATMENT PROCEDURE – CHEMOTHERAPY
Myeloma treatment generally depends on the stage of the cancer. For patients with multiple myeloma, chemotherapy is typically given orally (by mouth, in pill form) or intravenously (by injection into the vein), which comprises of a single or a combination of drugs. Conventionally, six to eight cycles of chemotherapy is administered followed by oral maintenance.
THE DRAWBACKS OF CHEMOTHERAPY
- Chemotherapy affects the bone marrow’s ability to produce adequate numbers of blood cells. As a result, the blood count (the number of white cells, platelets and red cells circulating in your blood) will generally fall within a week of treatment. When the platelet count is extremely low, the patient can bruise and bleed more easily
- If the red blood cell count and haemoglobin levels drop, the patient will probably become anaemic (condition where there aren’t enough healthy red blood cells to carry adequate oxygen to the body’s tissues)
- Though chemotherapy will achieve initial control, the chances of the disease recurring early within the first 3 years is very high
CHANGE IN TREATMENT PARADIGM
There have been major advances in the last 5 years in the diagnosis and treatment of myeloma. The internationally-accepted standard of treatment when it comes to myeloma patients is to give:
- 3 to 4 cycles of Novel Agent combination therapy (Novel agents are new-age drugs which don’t cause the side effects of chemotherapy, like hair loss, mouth ulcers or dangerously low blood count)
- Followed by Bone Marrow Transplant
- And oral drugs for maintenance post-discharge
There are novel agents which are independent of chemotherapy, making the treatment of this disease very effective, thereby increasing the life expectancy to many more years, compared to what standard chemotherapy can achieve. Though these drugs give us a deeper understanding of treating myeloma and a control over the disease, curing myeloma fully is rare.
TREATMENT AT MIOT
While many hospitals resort to 6-8 cycles of chemotherapy as a treatment method for myeloma, MIOT is one of the few Bone Marrow Transplant centres in the country equipped to follow the internationally-accepted standard of treatment for this condition.
MYELOMA PROTOCOL at MIOT
Our protocol in patients up to 70 years of age:
- Give three to four cycles of novel agent combinations. Once they respond well, perform an early Bone Marrow Transplant
- By doing this, we can reduce the hospitalization time to less than 3 months and manage patient more as OP
- We have got deeper responses by doing this and >80% of our patients are disease-free over last 5 years. They’re only on oral maintenance drugs
- We have successfully completed 100 myeloma transplants
- Our oldest Myeloma patient was 72 years when transplant was done and he is still free of disease at 79
- We have reduced the cost of transplant. The cost is reduced by almost 20 times when compared to the western countries with a comparable outcome
- Being a multispecialty hospital, it’s easier for us to collaborate with multiple departments for faster diagnosis and early treatment before the condition progresses
- Newer therapies like CAR-T cell are in the pipeline for patients with refractory disease
MIOT MYELOMA CONCLAVE 2019 DISTINGUISHED KEYNOTE SPEAKER
MIOT has invited Dr. Vincent Rajkumar of Mayo Clinic (a leading hospital in the US) to share his experiences and latest developments in myeloma treatment. It is a rare opportunity not only for MIOT’s own doctors, but for the entire medical fraternity in Chennai.
Dr. Vincent Rajkumar is considered as one of the world’s leading authorities in the field of myeloma. It was he who led the shift from conventional chemotherapy to novel agents. Dr. Rajkumar is engaged in clinical, epidemiological and laboratory research in myeloma and related disorders. He served as the principal investigator on several clinical trials for the treatment of myeloma, including the pivotal trials that led to the regulatory approval of thalidomide (the first novel agent) for the treatment of the disease in the United States.
Apart from enlightening the medical fraternity, MIOT MYELOMA CONCLAVE 2019 aims to spread awareness among the general public and help them choose the right treatment and hospital.
About MIOT Institute of Haematology, Haemato-oncology and Bone Marrow Transplant
MIOT International caters to the specialised haematological needs in all specialities under one roof through the MIOT Institute of Haematology, Haemato-oncology and Bone Marrow Transplant. Over the years MIOT has developed as a centre of excellence in Leukaemia, Myeloma and Lymphoma treating all types of complex and relapsed cases. The centre’s comprehensive, state-of-the-art facility is easily the most advanced in the country and is headed by an expert team of highly qualified specialists who have worked in some of the best medical centres across the world.
Milestones
- One of the earliest centres in the country to do T- Replete Haplo-Identical Bone Marrow Transplant
- First and one of the biggest centre in Tamil Nadu to have a valid bone marrow transplant license
- MIOT has in-house Flow Cytometry, stem cell processing and Cryopreservation facility
- The centre has done transplants in nearly all transplantable haematological conditions like Leukaemia, Myeloma, Lymphoma, Thalassemia and Sickle cell anaemia
- Haemato-Oncology & Bone Marrow Transplant Centre has completed more than 273 Bone Marrow Transplantssince 2013 with a success rate on par with the best centres in the world.