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Is Multiple Myeloma Relapse Treatable?

Relapsed Multiple Myeloma Treatment

Navigating the complexities of relapsed multiple myeloma requires understanding its nature, challenges and the advanced treatment options available. This disease, characterized by the malignant proliferation of plasma cells in the bone marrow, often shows a tendency to relapse even after initial treatment.

Recognizing the signs of relapse, understanding its frequency and impact on various organs, and being aware of the latest diagnostic and treatment methods are crucial for effective management.

What Is Considered a Relapse in Multiple Myeloma?

In the context of multiple myeloma, a relapse refers to the return of the disease after a period of remission. Remission in multiple myeloma is characterized by a significant reduction or disappearance of the disease's signs and symptoms. This can occur after initial treatment or after a period of stable disease without progression. A relapse is typically identified through various indicators. These include:

Increased Myeloma Markers

The reappearance or rise in specific markers in the blood or urine, such as monoclonal protein (M-protein), indicates increased activity by multiple myeloma cells. These markers are initially used to diagnose and monitor the disease’s progression and response to treatment.

Clinical Symptoms

The return or worsening of symptoms associated with multiple myeloma, such as bone pain, fatigue, or kidney dysfunction, can signal a relapse. This is particularly significant if these symptoms correlate with laboratory findings.

Radiologic Evidence

Imaging tests, such as X-rays, MRIs or PET scans, might show new or growing areas of bone disease or soft tissue plasmacytomas, which are indicative of relapse or progression.

Bone Marrow Biopsy Findings

A bone marrow biopsy may reveal an increased number of myeloma cells. This is a direct indication of the disease’s resurgence, as it shows an active proliferation of malignant plasma cells in the bone marrow.

Decreased Blood Counts

A drop in red or white blood cell counts or platelets, often referred to as cytopenias, can be a sign of relapsed multiple myeloma, especially if linked with other symptoms or test results.

It’s important to note that a relapse can occur at any time and varies greatly from patient to patient. Some individuals may experience a relapse soon after treatment, while others may have years of remission before the disease returns. The nature of multiple myeloma as a chronic condition means that relapses are, unfortunately, a common aspect of the disease’s progression.

How Often Does Multiple Myeloma Relapse?

Multiple myeloma has a notable propensity for relapse even after treatment. Relapse rates for this disease provide insight into its challenging and recurrent nature.

Short-Term Relapse

Approximately 16% of people with multiple myeloma experience a relapse within the first year following diagnosis and treatment.

Long-Term Trends

The likelihood of relapse increases significantly over time. After about four years from initial treatment, almost 66% of patients are reported to have experienced a relapse.

Average Time to Relapse

The median time to relapse for multiple myeloma is around 26 months.

Prognosis after Early Relapse

Individuals who relapse within the first 12 months post-treatment often face a poorer prognosis and lower survival rates compared to those who have longer periods of remission.

What Organs Does Multiple Myeloma Affect After a Relapse?

Multiple myeloma primarily affects the bone marrow but can also impact various organs and systems in the body, especially after a relapse. Some of the key organs and systems affected include:

Bones: One of the most common areas affected by multiple myeloma. The proliferation of myeloma cells in the bone marrow can lead to bone pain, lesions, and an increased risk of fractures. After a relapse, these symptoms can become more severe or widespread.

Kidneys: Renal impairment or failure is a significant concern in multiple myeloma, often due to the accumulation of abnormal proteins produced by myeloma cells. Kidney function can deteriorate further after a relapse, leading to complications like proteinuria (excess protein in urine) and elevated creatinine levels.

Blood System: Multiple myeloma can cause anemia (low red blood cell count), leukopenia (low white blood cell count) and thrombocytopenia (low platelet count). These conditions may worsen after a relapse, leading to increased fatigue, susceptibility to infections and bleeding tendencies.

Nervous System: Myeloma cells and related bone lesions can compress nerves, leading to neurological symptoms like numbness, tingling, or pain. Spinal cord compression is a serious complication that can occur, particularly after relapse.

Immune System: The disease and its treatment can weaken the immune system, making patients more susceptible to infections. After a relapse, this immunocompromised state can become more pronounced.

Soft Tissues: In some cases, extramedullary disease (myeloma cells growing outside the bone marrow) can occur, affecting soft tissues and organs like the liver, spleen and lymph nodes.

It’s important to note that the extent and severity of organ involvement in relapsed multiple myeloma can vary greatly among individuals. The disease’s impact is influenced by factors like the patient’s overall health, the aggressiveness of the cancer and the specific genetic characteristics of the myeloma cells.

What Are the Symptoms of Relapsed Multiple Myeloma?

Relapsed multiple myeloma can present with a range of symptoms, some of which may be similar to those experienced at the initial diagnosis, while others may be new or more severe. Common symptoms include:

Bone Pain

One of the most common symptoms, often caused by bone lesions or fractures. The pain is typically persistent and may worsen with movement.

Fatigue and Weakness

These are common due to anemia, a condition where there aren't enough healthy red blood cells to carry adequate oxygen to the body's tissues.

Frequent Infections

Due to the weakened immune system, patients may experience more frequent bacterial or viral infections.

Kidney Problems

Symptoms like reduced urine output, swelling in legs, or changes in urine color can indicate kidney issues caused by the accumulation of myeloma proteins.

High Calcium Levels

Elevated calcium levels due to bone breakdown can lead to excessive thirst, frequent urination, constipation, nausea or confusion.

Nerve Damage

Symptoms such as numbness, tingling, or burning sensations, particularly in the legs and lower back, can occur due to nerve damage caused by myeloma cells.

Weight Loss and Loss of Appetite

These can be signs of the general progression of the disease.

Shortness of Breath

This can be due to anemia or kidney problems, leading to fluid buildup in the lungs.

The management of relapsed multiple myeloma often requires a comprehensive approach, including adjustments to treatment plans, supportive care and sometimes palliative care to manage symptoms and improve quality of life.

How Is Relapsed Multiple Myeloma Diagnosed?

Diagnosing a relapse in multiple myeloma involves a combination of clinical assessment, laboratory tests, and imaging studies. The key steps in the process include:

Clinical Evaluation

This involves a thorough assessment of the patient’s symptoms, medical history, and a physical examination. The doctor will look for signs of disease progression, such as new or worsening bone pain, fatigue or symptoms of kidney dysfunction.

Laboratory Tests

Blood and urine tests are essential in diagnosing a relapse.

Imaging Studies

Imaging tests help in detecting bone damage or lesions caused by myeloma cells.

Bone Marrow Biopsy

A biopsy, often from the pelvic bone, is performed to assess the percentage of myeloma cells in the bone marrow. This can confirm a diagnosis of relapse and provide information on the aggressiveness of the disease.

Genetic Testing

Analyzing myeloma cells for genetic abnormalities can help in determining the prognosis and guiding treatment choices.

It’s important to note that the approach to diagnosing a relapse may vary based on individual patient factors and the symptoms they present.

What Are the Treatment Options for Relapsed Multiple Myeloma?

The treatment of relapsed multiple myeloma is tailored to the individual patient, taking into account the specifics of the disease’s progression, previous treatments and the patient’s overall health. Key treatment options include:

  • Chemotherapy
  • Targeted Therapy
  • Radiation Therapy
  • Bone Marrow Transplantation
  • Corticosteroids
  • Clinical Trials
  • CAR T-Cell Therapy

The choice of treatment depends on various factors, including the features of the myeloma at relapse, previous therapies and their side effects, the patient’s age and overall health, and patient preferences.

Car T-Cell Therapy for Relapsed Multiple Myeloma at Sheba Medical Center

Sheba Medical Center is at the forefront of treating relapsed multiple myeloma with CAR T-cell therapy, a cutting-edge cancer immunotherapy. Sheba is unique in that it engineers the CAR T-cells in-house in a specialized laboratory, streamlining the process from lymphocyte collection to patient delivery to about 10 days. This contrasts with other hospitals where commercial CARs are used, often taking months to become available.

Originally used for leukemia and lymphoma, CAR T-cell therapy has now expanded to multiple myeloma treatment. It involves genetically modifying the patient’s T-cells to more effectively recognize and attack myeloma cells, harnessing the body’s immune system against cancer. This therapy offers new hope for better outcomes in patients with relapsed multiple myeloma.

Why Should You Choose Sheba Medical Center for Relapsed Multiple Myeloma Treatment?

Choosing Sheba Medical Center for the treatment of relapsed multiple myeloma offers several advantages, making it a preferred destination for patients seeking effective and innovative care. Sheba offers:

Advanced Treatment

Sheba Medical Center is renowned for its pioneering treatments, including the use of CAR T-cell therapy for multiple myeloma. The center’s commitment to innovation means patients have access to the latest therapies and clinical trials, often unavailable elsewhere.

Quality of Care

Sheba Medical Center is recognized for its comprehensive and patient-centered approach. The center offers a multidisciplinary team of specialists, including oncologists, hematologists, radiologists, and supportive care experts, ensuring all aspects of a patient’s condition are addressed.

Cost Considerations

While offering cutting-edge treatments, Sheba Medical Center is also known for its cost-effective care. The center provides high quality medical services at competitive rates compared to other leading hospitals globally.

These factors combined make Sheba Medical Center a leading choice for patients with relapsed multiple myeloma, offering state-of-the-art treatment, expert care and a commitment to patient wellbeing and recovery.

The Benefits of Getting Relapsed Multiple Myeloma Treatment at Sheba Medical Center

Sheba Medical Center offers a range of benefits for patients undergoing treatment for relapsed multiple myeloma, highlighted by its advanced medical practices and patient-centric approach. Key benefits include:

In-House CAR T-Cell Engineering

A standout feature of Sheba Medical Center is its in-house engineering of CAR T-cells. This not only streamlines the treatment process, reducing the time from collection to delivery to about 10 days, but also ensures a high degree of customization and adaptability to individual patient needs.

Expert Medical Team

Sheba Medical Center boasts a team of experts across various specialties, including oncologists, hematologists, and supportive care professionals. This multidisciplinary team ensures comprehensive care, from diagnosis to treatment and follow-up, incorporating the latest medical advances.

Research and Innovation

Sheba Medical Center is at the forefront of medical research and innovation, particularly in the field of hematology and oncology. Access to cutting-edge research and participation in clinical trials offers patients the most advanced treatment options available.

International Recognition

The center is globally recognized for its high standards of medical care, innovative treatments, and contributions to medical research. This reputation assures patients that they are receiving world-class care when being treated for multiple myeloma.

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