Myeloma 101
Talking to Your Doctor
July 26, 2008
Boston, Massachusetts
Brian G.M. Durie, M.D.
Features
Featur
of Myeloma
How Patients Present 2008
BONE ISSUES
30%
ROUTINE PHYSICAL
PHYSICAL
25%
ELEVATED urine/serum protein
15%
ANEMIA/FA
ANEMIA/F T
A IGUE
15%
INFECTION
3%
RENAL DYSFUNCTION
DYSFUNCTION
2%
MISCELLANEOUS
10%
Is there active Myeloma?
MGUS
PC < 10%; SPIKE <3.0G/DL
Smoldering
not MGUS or MM; D/S stage
stage IA
Active Myeloma*
Calcium
C
elevation (>10.5 g/dL)
g/dL)
Renal insufficiency (CREAT >2
mg/dL)
Anemia (Hb <10 or 2 g <Normal)
Bone disease (Lytic or Osteopenic)
*MM is same as Durie/Salmon stage IB plus stage II/III A/B;
British J. Haematol. 2003;121:749-757.
Talking to Your Doctor
For Success
You Need...
Trust
2-way Communication
Communication
Clear Goals/Objectives
Collaboration on the details
Friendship if possible
...or maybe a new doctor
First
Confirm Diagnosis
Diagnosis
Set plans for treatment
Establish schedule
schedule for
for tests
Understand initial time frame
Know the longer term expectations
Allow time to move from FEAR
HOPE
Decision Process
1. Treatment Required
Transplant- Yes
Transplan
p
t-No
(No Melphalan)
(Melphalan OK)
Transplant- Maybe
(No Melphalan)
Melphalan)
2. Prognostic Factors
Poor
Good
Unknown
i.e. shorter response
expected
Treatment Details
Which for myeloma?
Which for
for bone/other?
How many cycles?
What about harvest/transplantation?
What about maintenance?
maintenance?
What's the back-up plan?
Side Effects
If neuropathy...
will dose be reduced?
Will Dex be
be...
high or low dose?
If DVT/VTE a irsk...
will aspirin/blood thinner be used?
What about infection...
will antibiotics be recommended?
Test Results
Which tests
tests and when?
when?
Blood
Ui
Urine
X-rays/scans
Bone marrow
Other
Can you get
i
cop es f
o ll
a
lt
resu s?
Back Up Treatments
What will make doctor change
treatments?
Lack of response?
Toxicity?
What is the back up plan?
Alternate combo?
New drug trial?
How does your doctor feel about
tran
ta sp
s l
p an
a t?
t
Yes / No
1 or 2
Mini-allo
Ht
Harvest only....
How do you feel about
tl
transpl t
an ?
t?
Maintenance
Yes/No
How long?
What about Aredia/Zometa?
When is new treatment
treatment required?
What About Other Issues
Work
Sleep
Food
Stress
Letting People Know (or Not)
Sleep and Exercise
Sleep and/or Naps...
Improve(s
( ) immunity
Reduce(s) stress
May help with weight
Exercise
Improves bone density
Critical for balance/
balance/
strength/ flexibility
Kl
Know your ilimitits
Food
10 Rules
1. Don't eat
eat anything your
your
grandmother wouldn't recognize.
2. ... avoid > 5 additives.
3. ... avoid "infinite"
infinite shelf life (pop
tarts).
4. Shop at the edge of the
supermarket (for
(for fresh
fresh produce).
5. ... avoid health problems.
6. ... eat at a table.
7. ... eat until /
4 5 full.
8. Pay more, eat less.
9. ... vary y
yyour diet.
10. Eat slowly....
Chocolate and Wine
Chocol t
a e
ti
contains
t
an iti i
ox d
idants
Many health promoting properties
from eating--
eating in moderation
Red wine has several benefits:
Resveratrol induces apoptosis
pp
of
myeloma cells
Can reduce aging and improve
cardiovascular health
To Reduce Stress, Make Changes
Life can be too fast...
Slow down & plan.
Plan For the Future
With Hope
Be ready for
whatever life offers
Stop to smell the roses
With
Less Stress
What about the big picture?
Ask for what you want.
Dare to take a risk.
Dream big.
Make time for what
matters.
Be Yourself.
Look for the best in everyone.
Have Fun!
Randy Pausch
Computer Scientist 2008