Within our bone marrow where blood cells are made, a battle can sometimes erupt between good and bad plasma cells.
Healthy plasma cells help fight infections by making proteins called antibodies that find and attack germs. But sometimes bad, cancerous plasma cells build up in the bone marrow and crowd out the healthy blood cells. Instead of making helpful antibodies, the cancer cells make proteins that don’t work right which lead to the complications of multiple myeloma.
“Think of the blood cells as an army,” said Alex Mejia Garcia, M.D., director of hematology and clinical research at Cleveland Clinic Indian River Hospital. “Within the army you have different groups like the Air Force and Marines, all fighting the bad guys or infections. One group becomes abnormal and become terrorists attacking the good guys. So, while the cells started out as fighters of infection, they become infected themselves and turn into myeloma.”
According to Mayo Clinic, the disease begins with one plasma cell in the bone marrow.
Something happens that turns the plasma cell into a cancerous myeloma cell. The myeloma cell multiplies quickly, and cancer cells build up in the bone marrow and crowd out the healthy blood cells. The myeloma cells continue trying to make antibodies, but the body can’t use the monoclonal (or M) proteins they produce. Instead, the M proteins build up, lowering the body’s ability to fight infections and causing damage to the kidneys and bones.
The exact cause of multiple myeloma remains a mystery, but several factors are thought to contribute to its development, including genetic predisposition. Those with a family history of multiple myeloma have a higher risk of developing the disease. Being over the age of 65 is another significant risk factor. Males get the disease more than women and Black Americans are more at risk than other groups.
“Typically, an individual will go to their primary care physician because they are suffering from fatigue or anemia,” said Dr. Mejia Garcia. “Or they show up in the emergency room with acute kidney failure or a fractured bone. Doctors diagnose the condition through blood and urine tests as well as bone marrow biopsies. Treatment for the disease will depend on the progression of the disease as well as the patient’s age and overall health.”
The first stage of treatment is likely to be targeted therapy with combination of immunotherapy drugs intended to kill as many myeloma cells as possible. The drugs are administered via a combination pills and subcutaneous injections.
A bone marrow transplant is the next step for patients who are viable candidates for the procedure. A bone marrow transplant, also known as a stem cell transplant, replaces diseased bone marrow with healthy bone marrow.
“The combination of treatments is the first step of cleaning the bad cells from the marrow so there’s a good population of good cells remaining in the marrow,” Dr. Mejia Garcia explained. “Once we know that’s the case, we collect the patient’s bone marrow with a machine and a catheter that goes into the blood vessels. Then we store those cells while the patient undergoes chemotherapy to destroy the diseased bone marrow. Chemotherapy is only used for patients getting a bone marrow transplant. After the chemotherapy, the stem cells are put back into your body where they travel to the bones and begin rebuilding bone marrow.”
Dr. Mejia Garcia likens the process to a rose garden overtaken by weeds. “The weeds are the cancer cells, the roses the healthy cells. You apply just enough weed killer (chemotherapy) to enable you to take out the roses and store them. Then you go back and apply a super weed killer to kill any weeds that are left. Only then do replant the roses when they can once again thrive in a healthy environment. The chemotherapy is used in preparation for the transplant.”
After treatment, the patient is put on a maintenance program and monitored closely. They may be given additional oral medication or subcutaneous injection therapy for a limited time depending on their recovery.
The American Cancer Society ranks multiple myeloma as the third most common hematological cancer, with 35,700 new cases diagnosed each year.
“Fortunately, there are new medications and treatments for multiple myeloma entering the marketplace and the survival rate has increased dramatically,” Dr. Mejia Garcia said. “Right now, the expected survival rate for a standard risk myeloma patient undergoing a transplant is more than 10 years. Just 20 years ago it was only six months.
“We now have medications that target plasma cells based on certain proteins that they express on their sources. And now we have smart ways to target them using immunotherapies. We have new BITEs (Bi-specific Antibodies) that bind proteins on cancer cells and cancer killing T cells to bring the patient’s own cancer-fighting cells in close proximity to cancer cells. We also have CAR-T or chimeric antigen receptor T-cells to target these plasma cells in an enhanced manner.”
Cancer care has become so complex and so specialized that each cancer has its own pill, and Dr. Mejia-Garcia aims to continue the refinement of care. Clinical trials are crucial in the search for new treatments and potential cures and Dr. Mejia Garcia was transferred to Cleveland Clinic’s Indian River Hospital from the healthcare company’s Ohio Taussig Cancer Institute with the goal of bringing preliminary cancer drug trials to Vero Beach.
Dr. Alex Mejia Garcia completed his hematology-oncology fellowship at Thomas Jefferson University in Philadelphia before pursuing a fellowship in cancer drug development at UT Health San Antonio MD-Mays Anderson Cancer Center in San Antonio. He then directed the early-stage drug development program for blood cancers at that institution. Later, he joined the Department of Hematology & Medical Oncology at Cleveland Clinic-Taussig Cancer Institute in Cleveland. His clinical and research focus has been on lymphomas and multiple myeloma. Dr. Mejia-Garcia’s office is in the Scully Welsh Cancer Center at Cleveland Clinic’s Indian River Hospital, 3555 10th Court, Vero Beach. The phone number is 772-563-4673.
