Tailored Treatment for Multiple Myeloma Yields Ideal Results

Feb 12, 2018 | Mayo Clinic Hematology Staff | @mayoclinichematologystaff


Original story from Sharing Mayo Clinic

When Diane Thompson was diagnosed with multiple myeloma in December 2014, she was given two years to live. At the time, her granddaughter was just 6 months old.

"I was worried that she wouldn't know who grandma is," Diane says. "It makes you look at life differently."

Diane's local oncologist referred her to Sikander Ailawadhi, M.D., a hematologist-oncologist at Mayo Clinic's Florida campus who specializes in multiple myeloma. The thorough care she received from Dr. Ailawadhi and the rest of her care team at Mayo Clinic Cancer Center not only took her beyond that two-year mark, it also put Diane's cancer in remission.

"We're on the cutting edge of information at Mayo Clinic, and we translated that into Mrs. Thompson's care, tailoring the treatment to her needs," Dr. Ailawadhi says.

For that, Diane is infinitely grateful.

"The staff is so caring and amazing," she says. "Everybody took such good care of me."

Moving in the right direction

Multiple myeloma is cancer that affects plasma cells — a type of white blood cell in the bone marrow. Diane was diagnosed with light chain myeloma, a less common, more aggressive variety of multiple myeloma that can lead to kidney damage. As a result, Diane developed chronic kidney disease. It was then that her doctor referred Diane to Mayo Clinic.

After her first consult with Dr. Ailawadhi in September 2015, Diane began a new medication, recently approved by the Food and Drug Administration, to reduce her light chain numbers. A normal light chain marker is around 2. Diane's was at 1,600.

"When she came to us she had a large disease burden. Mere improvement wasn't enough. I wanted a fast and deep response." — Sikander Ailawadhi, M.D.

"When she came to us, she had a large disease burden," Dr. Ailawadhi says. "Mere improvement wasn't enough. I wanted a fast and deep response."

Diane quickly saw improvement as a result of the treatment. "After just a month, my numbers came slashing down," she says.

But the medication alone wasn't likely to be enough. Dr. Ailawadhi discussed with Diane the possibility of a bone marrow transplant. The procedure involves high-dose chemotherapy to get rid of the cancer cells in the bone marrow, followed by an infusion of healthy blood stem cells into the body to help the bone marrow recover.

Because the transplant initially wipes out the immune system, Diane was not sure she wanted to go through it.

"The transplant was going to make me not feel well for about six months, and I was going to need to be in isolation for some time, away from my family and friends," Diane says. "When you're given just a few years, you don't want to give up that much time."

Taking the next step

By early 2017, Diane had received a significant response from the new medication. But Dr. Ailawadhi was not yet satisfied.

"The depth of response is extremely important in myeloma, especially for younger, otherwise healthy patients. Diane had never reached the deep response that is possible with today's available management," Dr. Ailawadhi says. "Multiple studies have shown that the deeper the response before a bone marrow transplant, the better the chances of the transplant in delaying the recurrence of disease."

Dr. Ailawadhi explained to Diane that she had relatively few treatment options available due to her advanced kidney disease. A bone marrow transplant was one of them. Diane decided to move forward. Her only condition was that they wait to do the procedure until after her daughter's wedding in May of that year. Dr. Ailawadhi agreed.

"I appreciated that Dr. Ailawadhi understood that family came first. That's why we do these things — to stay around for these joyful occasions." — Diane Thompson

The transplant was set for June 6. Dr. Ailawadhi put Diane on a relatively aggressive treatment for a few months before the wedding to give her a better chance of disease control for the event. It worked. For the first time since her diagnosis, Diane achieved a deep response and could fully participate with her family at the wedding.

"I appreciated that Dr. Ailawadhi understood that family came first," Diane says. "That's why we do these things — to stay around for these joyful occasions."

Receiving excellent news

About three weeks after the wedding, Diane went in for her bone marrow transplant. She stayed in the hospital for 16 days to allow her immune system to recover. When she returned for a bone marrow biopsy 100 days later, she received some unexpected news.

"Dr. Ailawadhi had the biggest smile on his face. He told me, 'You're in complete remission,' and I broke down in tears," Diane says. "I was hoping to get extra time, but I had no idea I would be cancer-free."

There's a bell on the eighth floor of the Davis Building that patients ring three times when they're cancer-free.

"Nobody's been given tomorrow, so I'm no different than anyone else. But I enjoy every day that I am given." — Diane Thompson

"Dr. Ailawadhi's staff all came out with me, and I rang the bell," Diane says. "Everyone in the lobby was clapping."

Diane's now back to her normal life, doing many of the things she enjoyed before she was diagnosed, like working part time, walking her dog, and spending lots of time with her daughters and grandchildren. She has follow-up visits every three months to monitor her disease.

"Dr. Ailawadhi knows how important it is for me to enjoy my family, and he gave that to me," Diane says, "Nobody's been given tomorrow, so I'm no different than anyone else. But I enjoy every day that I am given."

Want to meet others discussing multiple myeloma? Check out the following discussions taking place on Connect:

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