Multiple Myeloma Support Group
Hamilton & District
Hamilton, Ontario, Canada


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SATURDAY MAY 14, 2005 MEETING

Welcome - Everyone was welcomed to the meeting.

OLD BUSINESS

i) Cell Phone Program
Just a reminder that we are still accepting cell phones; both working and non-working. If anyone is interested in taking on this project, please let Laura McCallum know. She would be happy to have someone work on this with her.

ii) International Myeloma Foundation Meeting
Just a reminder that the International Myeloma Foundation will be hosting a family and patient conference on Friday, July 22nd and Saturday, July 23rd in Toronto. The cost is $75.00 for one day, and $100.00 for two days. There will be a discount for early bookings. Registration can be done on-line.

iii) Myeloma Canada
It was suggested that everyone e-mail their MPPs regarding obtaining approval for velcade. The e-mail address is www.myelomacanada.ca. The section on Advocacy will link you to your MPP’s office, either by an email or regular mail address.

NEW BUSINESS

i) Announcement
The group was regrettably informed that one of the members, Gail Williams, passed away on May 3, 2005.

ii) Multiple Myeloma Presentation - Dr. T. Kouroukis

Dr. Kouroukis is a hematologist at the Juravinski Cancer Centre. He also sits on the Practice Guidelines Committee whereby they decide which drugs should be funded, and how the drugs should be administered. He has recently submitted a paper to Drug Programs to request coverage of velcade. He was introduced and welcomed.

Dr. Kouroukis discussed multiple myeloma including some background about the immune system, the bone marrow, the myeloma tests and staging, myeloma treatment, and supportive care issues.

The immune system is required to protect people against invaders such as bacteria and viruses. It is important in terms of tissue healing. It is a self-regulating system, and absence of the immune system could lead to major problems. Components of the immune system include lymph nodes, lymphatic vessels, spleen, blood cells such as lymphocytes, plasma cells, macrophages, and antibodies (IgG, IgM, IgA, etc).

The bone marrow consists of tissue in which all blood cells are made (white blood cells, red blood cells and platelets). It is found in the long bones, spine, pelvis, and skull. Other cells include stromal cells (background supporting cells in the bone marrow).

Multiple myeloma is a cancer of the plasma cells. Plasma cells are in the bone marrow, and make antibody proteins to fight infection. Myeloma consists of 1% of all cancers, and 10% of blood cancers. The incidence of myeloma is 1,693 new persons per year in Canada; 888 men, and 805 women.

There are four types of myeloma:

a) Smouldering – The protein level is a little low, but the rest of the blood counts are good, the CT is normal, and there are a few cells found in the biopsy. Treatment is not required immediately.

b) Non Secretory – This myeloma does not make protein, which makes it difficult to detect if the treatment is working.

c) Solitary Plasmacytoma - There is a single site of disease, there is no evidence of generalized myeloma, radiation is the choice of treatment, and there is a risk of recurrence or generalized myeloma.

d) Secretory – This myeloma manufactures a protein that can be measured in the blood and urine.

Symptoms of myeloma include fatigue, frequent infections, bone pain, and kidney problems. It may also be detected through blood counts.

Effects of myeloma could include anemia, low platelets, low white blood cells, bone pain, fractures, difficulty walking, constipation, abdominal pain fatigue, change in urine, bleeding, headaches or blurred vision.

Staging tests used to stage myeloma include blood tests (CBC, M Protein, creatinine, albumin, beta-2microglobulinemia), x-rays, urine testing (Bence-Jones protein), and bone marrow testing.

Treatment factors are determined by age, associated illnesses, organ function, myeloma risk factors, complications of the myeloma, previous treatment or not, and preferences.

International Staging System (ISS):

The International Staging System is an updated staging system for multiple myeloma. Institutions around the world have submitted over 10,000 cancer cases diagnosed in previous years for data collection and analysis in developing a new myeloma staging system.

The International Staging System is an important project for patients in the short-term because based on the data collected thus far, outcome information has been received from these patients and it is known if or how these patients have responded to treatment. Factors variables play an important role with the International Prognostic Index (IPI) because we know which factors are most predictive in the myeloma patient. High predictor factors include Beta 2, serum albumin, platelet count, calcium, hemoglobin level, age, chromosome 13 and performance status.

Based on the strong indicators from the ISS data, groups of myeloma patients can be established, e.g. high risk, non-high risk, and it can be determined if the patient will do well or not.

Albumin is routinely done. The Beta-2-microglobulin is not done in Hamilton, but we hope to have it available at some time in the near future.

Durie-Salmon Staging:

Currently, the classification of Durie and Salmon is used for staging multiple myeloma. This staging system correlates well with tumor mass and prognosis. The Durie-Salmon staging is as follows:

STAGE I (all of the following):
Hemoglobin greater than 10 g/dl
Serum calcium less than 12 mg/dl
Normal bone structure or solitary plasmacytoma on radiographs
Low M component (IgG less than 5 g/dl; IgA less than 3 g/dl; urine light chains less than 4 g/24 hr.)

STAGE II
Fitting neither Stage I nor Stage III.

STAGE III (one or more of the following):
Hemoglobin les than 8.5 g/dl
Serum calcium greater than 12 mg/dl
Advanced lytic bone lesions or
Hyper M component (IgG greater than 7 g/dl; IgA greater than 5 g/dl; urinary light chains greater than 12 g/24 hr).

The following are treatment options:

a) Pamidronate:

Pamidronate is an osteoporosis drug. It is given monthly through intravenous infusion. This drug maintains bone strength, prevents fractures, and improves pain. However, in long-term treatment, the kidney function must be watched. Other drugs in this category include clodronate and zolendronate.

b) Chemotherapy:

Chemotherapy treatment options consist of melphalan and prednisone, vincristine, doxorubicin, and dexamethasone (VAD), transplantation, cyclophosphamide, dexamethasone, velcade and thalidomide.

Some of the side effects that can be associated with velcade include tiredness, painful tingling and numbness (peripheral neuropathy), gastrointestinal problems such as diarrhea and constipation, and mild effects on blood work.

c) Transplant:

Transplantation allows for delivery of high doses of chemotherapy, and the stem cells “kick start” blood count recovery. There are three types of transplants; one is an autologous transplant (peripheral blood stem cells), the second is a tandem (double) transplant, and the third is a mini (allogeneic) transplant.

d) Irradiation:

Irradiation is used to treat bones that might be at risk of fracture, to treat spinal cord or nerve compression, to treat painful bones, and to treat plasmacytomas.

Supportive care issues include:

a) Anemia:

Anemia is quite common in myeloma. Up to 2/3 of patients have significant anemia. This occurs when there is a reduction below normal in the number of erythrocytes (red blood cells) per cu. mm in the quantity of hemoglobin, or in the volume of packed red cells.

b) Infections:

Bacterial and viral Infections are commonly caused by immune dysfunction, and chemotherapy effect. Immunizations such as pneumovax and influenza vaccine should be obtained, and hand washing and mouth care are essential in decreasing the risk of infections.

c) Pain Control:

To control your pain, it is important to tailor your activities. Pain medication such as acetaminophen, non-steroidal anti-inflammatories, and narcotics may also be taken to alleviate the pain. For severe problems, procedures such as vertebroplasty, kyphoplasty, and nerve blocks may be performed.

BANK FOR A CURE

In the near future, the International Myeloma Foundation (IMF) will be providing bottles to the group in order to collect DNA samples from saliva in the mouth. These samples will be sent back to the States for analyzing in order to establish DNA profiles for myeloma.

NEXT MEETING

The next meeting will take place on Saturday, July 9th at 1:00 p.m. at the Linden Park community Church. Our speaker will be Dr. Ralph Meyer.