2022 Southern Medical Research Conference
How My Training Helps Me To Address Health Disparities In Multiple Myeloma
Irene Ghobrial (front, centre, blue dress) leads a multidisciplinary team that addresses health disparities in multiple myeloma at the Dana-Farber Cancer Institute.Credit: Dana-Farber Cancer Institute
Irene Ghobrial leads Stand Up To Cancer's Multiple Myeloma Dream Team, which is a part of the research charity that investigates conditions that could lead to this type of bone marrow cancer, which kills 106,000 people annually. Ghobrial, a medical oncologist at the Dana-Farber Cancer Institute and Harvard Medical School, both in Boston, Massachusetts, describes her journey as an immigrant woman of colour to the United States. She explains why translational research is key to advancing personalized treatments and how her team addresses health disparities.
What challenges did you face as an early-career researcher after moving to the United States from Egypt?I graduated in medicine from Cairo University in 1999 and moved to Detroit, Michigan, for training opportunities that were inaccessible to me in Egypt. I faced many challenges and mistreatment, sometimes driven by discrimination towards me as a woman and an immigrant. The chances of getting into elite training programmes when you belong to a minority group are slim. Sometimes, I was oblivious to these barriers, and not knowing about them helped me to persevere and persist.
Outlook: Multiple myeloma
I couldn't have dreamt of this life when I was younger. Sometimes, I pinch myself and say, "I'm living the American dream, right?" — as an Egyptian immigrant and woman of colour who is now an associate professor of medicine at Harvard Medical School. But, as the saying goes, it took a village. My parents and mentors inspired me to dream big. And despite barriers to success faced by minority groups, the US system still allows people to thrive regardless of where they came from and who they are.
How has being an oncologist affected the way you conduct research?In 2000, I worked in an immunology laboratory run by Karen Hedin at the Mayo Clinic in Rochester, Minnesota, looking at chemokine receptor signalling in immune cells. I've been in love with research ever since. As a clinician-researcher, you can take samples from your patients, do whole-genome sequencing, get the answers you need and use them to personalize treatment. This back-and-forth is gratifying and exciting.
How did you first get interested in multiple myeloma prevention?Multiple myeloma is a cancer of plasma cells, white blood cells that make antibodies. In myeloma, these cells grow uncontrollably in the bones and produce an overabundance of abnormal immunoglobulin proteins.
Collection: Co-production of research
Myeloma develops in about 160,000 people every year worldwide. Although rare, it is the most common blood cancer in African Americans, who are twice as likely to have it as white Americans. They're also likely to develop it at a younger age.
Myeloma might cause no symptoms in its early stages, but people with more-advanced forms of the disease can have bone pain, fractures, recurring infections, hypercalcaemia (higher-than-normal calcium levels) and anaemia.
The condition is not yet curable. But there are treatments to prevent and manage symptoms, slow disease progression and improve a person's quality of life. Treatment might involve chemotherapy and other cancer-fighting drugs, as well as steroids, bone-modifying medications and bone-marrow transplants.
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I trained at Mayo with Robert (Bob) Kyle, whom I call the grandfather of myeloma, who influenced my interest in multiple myeloma. He named two of the precursor conditions that cause no symptoms but might develop into myeloma: monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM).
Unlike many of his peers in the 1970s, Bob didn't dismiss these conditions simply because they seemed benign. Instead, he focused on understanding what causes them to develop into myeloma, and he emphasized that people with precursor conditions should be monitored closely.
How does your team apply its motto — 'the fierce urgency of now' — to its everyday work?Our patients need our research to answer their health concerns, not in the next 10 or 15 years, but now. If we can diagnose and treat myeloma early, we can make a difference.
My team works fast and hard to sequence and do mass spectrometry to analyse patient samples and get the data back to them. Working this way takes a lot of effort — but it's also a lot of fun.
My team is multidisciplinary and includes people with MDs or PhDs, as well as students. They work in biology, chemistry, bioinformatics, epidemiology, medicine and statistics. Every person on the team is complementary to the others.
Our team received a US$10 million award and began work in April 2018. Our study, called PROMISE, focuses on understanding these precursor conditions to predict the risk of developing myeloma. We will screen 30,000 individuals at risk of myeloma, including African Americans, people of African descent and people with first-degree family members who have had blood cancer.
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To help potential participants gain trust and confidence in our research, we educate them about multiple myeloma and its prevalence in African Americans, and explain that screening for precursor conditions can improve survival outcomes.
In July 2022, we screened 200 African American people at a health-fair event in Indianapolis. One woman was scared because she had a relative with myeloma. After convincing her, she took the test. Her results showed that she might have gone on to develop myeloma with kidney failure in a few weeks. We therefore referred her for standard myeloma therapy that week, which should protect her from developing myeloma and kidney damage.
What can you tell us about the PROMISE study's findings so far, and their significance?We published results1 for the first 7,600 patients screened by mass spectrometry for monoclonal gammopathies, the abnormal immunoglobulins in the blood. We were surprised that 13% of the participants had MGUS, a high proportion compared with the 3–5% prevalence expected in the general population.
We also found that another 20% of participants had very low levels of these abnormal proteins, and we named this new precursor condition monoclonal gammopathy of indeterminate potential, or MGIP. Now, we're trying to understand what MGIP is. So far, our findings suggest that it might be a sign of early B-cell malignancies — such as chronic lymphocytic leukaemia. If so, it's possible that MGIP could be treated and cured in some people, before it progresses to later stages of blood cancers. It's exciting that we have the potential of understanding MGIP better, to help prevent the progression of blood cancers.
Stage 3 Multiple Myeloma: Symptoms, Progression, And Life Expectancy
Multiple myeloma is cancer that affects the bone marrow and a type of blood cell known as plasma cells. In stage 3 myeloma, the cancer has reached various parts of the body.
People do not often experience multiple myeloma symptoms until they reach stage 3. At this stage, the cancer affects multiple areas of the body, causing complex symptoms.
There is currently no cure for multiple myeloma, but treatment is available. In this article, we explain the staging and progression, as well as life expectancy and outlook.
Myeloma creates abnormal plasma cells, leaving less room for the normal white and red blood cells that keep the body healthy.
When the myeloma cells divide and grow, they can cause damage to the bones and affect the blood, kidneys, and immune system.
All cancers are given stage numbers that refer to how far the disease has progressed in an individual. This can help doctors decide on the best course of treatment. It will also give them an idea of how the cancer is likely to progress.
Doctors use the international staging system (ISS) to determine the stage of the disease. Multiple myeloma is given a stage number of 1, 2, or 3 based on the results of two blood tests.
The stages of myeloma are:
Life expectancy means how long a person with stage 3 multiple myeloma might expect to live once treatment begins. It can also be called the survival rate or median survival.
Median survival is found using data from a large group of people with multiple myeloma. This figure is the amount of time between first treatment and death.
Scientists find the median by looking at half of the people in the study. This means that it is approximate and is not an exact prediction of life expectancy.
The American Cancer Society guidelines for the life expectancy of people with multiple myeloma are:
Stage Median survival 1 62 months 2 44 months 3 29 monthsEveryone is different, so a person's age, their treatment, and other factors will affect their outlook. A doctor will be able to look at an individual's specific situation and give the person a more accurate estimate.
As multiple myeloma progresses, a person is likely to experience more symptoms of the disease. They may also experience bothersome side effects from medication and treatment.
Multiple myeloma often weakens the bones and may cause fractures. Bones in the spine can collapse and damage the spinal cord, which is a collection of nerves in the back. This may cause a tingling feeling or numbness in the legs and feet.
Bones may become damaged, fractured, or painful. Bone damage may put pressure on the spine and cause back pain.
Multiple myeloma can prevent the body from making enough healthy red blood cells. When there are not enough red blood cells in the body, a person may develop anemia. Anemia can make a person feel very tired, weak, or short of breath.
A high level of calcium in the blood is known as hypercalcemia. Too much calcium in the blood can cause low energy, sickness, dehydration, and constipation.
Multiple myeloma and its treatments can also damage the kidneys. If the kidneys stop working properly, a person may experience a range of symptoms including tiredness, itchy skin, swollen ankles, losing weight or not wanting to eat, and nausea.
Additionally, multiple myeloma can weaken a person's immune system. The immune system protects the body from disease, so a person may become more susceptible to serious infections.
If a person has symptoms of an infection, such as a raised temperature and increased heart rate, they should seek medical attention as soon as possible.
Many of these symptoms can be managed with medication and treatment. A person with multiple myeloma will need regular checkup appointments to monitor the progression of the disease and whether treatment is working.
People with multiple myeloma should always seek medical attention if their symptoms change or get worse.
Share on PinterestA variety of medications may be prescribed for treating stage 3 multiple myeloma.While there is no cure for multiple myeloma, treatment is available. Treatment aims to improve a person's quality of life and prevent the cancer spreading further.
Treatment can also help with symptoms caused by multiple myeloma, such as bone pain and lack of energy.
A person with multiple myeloma that is stage 2 or higher will probably be offered medication to help keep their bones strong if the cancer has weakened them. A combination of drugs, including chemotherapy drugs, usually works best.
Multiple myeloma stops stem cells from working properly. These are the cells that create new blood cells. A stem cell transplant replaces diseased stem cells with healthy ones and is often used to treat this form of cancer.
A person with multiple myeloma is likely to have a low blood count. This means that they have fewer blood cells than average and may need a transfusion.
Antibiotics and painkillers can help to treat any infections and relieve pain.
Clinical trials help medical professionals find better ways to treat illness and disease. A person having treatment for multiple myeloma may be asked to take part in a clinical trial to test new treatments and medications.
Living with cancer can be challenging, so it helps to have support from friends, family, and support groups with other people who have multiple myeloma. People may also find support from charitable organizations and online communities.
There are some lifestyle changes that a person with multiple myeloma can make to help them cope with symptoms. These include:
People can also choose some complementary therapies, such as massage or meditation, to reduce stress and improve their overall well-being. It is essential to use these therapies alongside traditional cancer treatment.
The average life expectancies for people with multiple myeloma are only approximations, as each person is different and will react to treatment differently. Living for longer than the average is possible, and treatments are constantly advancing through clinical trials.
Understanding life expectancy and outlook can help someone to plan, find support, and decide on the best treatment for them.
Facts About Multiple Myeloma
Understanding Multiple MyelomaMultiple myeloma is a bone marrow cancer. It can affect your bones and kidneys, as well as your levels of healthy blood cells. It is a fairly rare cancer, with just under 35,000 new cases diagnosed each year. Multiple myeloma happens when cancerous plasma cells (white blood cells that make antibodies) build up in your marrow and crowd out healthy blood cells. The word "multiple" means that cancer cells are found in more than one area of the body. Smoldering myeloma and monoclonal gammopathy of undetermined significance (MGUS) are conditions that can happen before multiple myeloma, but these conditions don't usually need treatment.
Confirming Your Multiple Myeloma DiagnosisThe first step in creating a treatment plan is checking your diagnosis of multiple myeloma or another plasma cell disorder.
Your physicians will use blood tests and a bone marrow biopsy to learn more about your myeloma, find out the stage of your cancer, get other information that can help predict what will happen with your disease and find out which organs in your body are affected.
Staging Multiple MyelomaStaging means finding out how far your multiple myeloma has spread. Knowing the stage of your cancer helps your physicians predict which treatments are most likely to control your disease or put it into remission.
StagesPhysicians use the Revised International Staging System (R-ISS) to stage multiple myeloma. It measures several different things in your body — albumin levels, Beta-2 microglobulin (B2M), lactate dehydrogenase (LDH) and genetic changes — to place you in one of three stages:
To find out how far your multiple myeloma has spread, your Physician will use blood tests and a bone marrow biopsy.
Most patients with myeloma have a protein that can be measured in their blood. This protein is called a monoclonal protein, or sometimes an M-spike or M-protein. The levels of this protein help your doctor understand the state of your disease.
Bone marrow biopsy and aspiration is another type of test that is often used. It is the best way to check the percentage of plasma cells in the bone marrow. For people who don't have multiple myeloma, blood plasma cells make up less than 5% of their cells. For people who have multiple myeloma, bone marrow plasma cell levels usually make up 10% or more of their cells.
If your disease is advanced, your physician may do imaging to see if there is any bone damage or large tumors. This imaging may be a whole-body low-dose CT scan, PET/CT scan, bone marrow MRI or skeletal survey.
Types of Treatment for Multiple MyelomaThere are more treatment options for multiple myeloma than ever before. No matter what type of treatment you need, multiple myeloma specialists at Fred Hutch will work closely with you, your family and each other to get you back to health.
Learn About Subtypes and Other Plasma Cell DisordersEach subtype of multiple myeloma acts differently. Fred Hutch physicians who specialize in multiple myeloma have a deep knowledge of these subtypes. They know which therapies to use and when to use them.
Fred Hutch has researched and treated Multiple Myeloma for decades. ResourcesThere are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.
Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community.
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Last Modified, May 20, 2023
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