The treatment of multiple myeloma has improved significantly in recent years, particularly with the advent of biological drugs, which target tumoural cells and their supportive structures, leaving healthy cells unharmed. But people are often diagnosed when the cancer is too advanced, which limits their treatment options considerably.


Early detection


The most common symptoms of multiple myeloma are back painwhich if severe may cause nerve damage (usually described as pins and needles in hands or feet) and fatigue due to anaemia, explains Dr Rakesh Popat, a consultant haematologist at University College London (UCL) Hospitals, and honorary clinical senior lecturer at the UCL Cancer Institute. Raising awareness of these symptoms can help ensure that more people are diagnosed early in the course of the disease. Furthermore, there are two benign conditions, called monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma, which can precede multiple myeloma. There is no treatment for these conditions but, if you detect them, you can monitor your patients and offer them treatment, as soon as they develop multiple myeloma, and before severe complications occur.


Personalized treatment


There are other issues that need to be addressed. Dr Popat notes, for example, the need to ensure that patients receive the most appropriate therapy for their type of multiple myeloma. Indeed, studies into the genetics of the condition have led to the identification of several different subtypes, which respond differently to different treatments. “We need to improve our understanding of which people respond best to which drugs, so that we can personalize their treatment and make it more effective,” says Dr Popat.


Managing complications


Dr Popat adds: “Another area in need of improvement is the management of the complications of multiple myeloma, such as bone fractures. Often, people with the condition develop fractures in their spine, which can result in chronic severe pain, as well as deformities that make it difficult to walk. Surgical interventions are available to address these problems but not all patients are accessing this type of treatment. We need to raise awareness of its usefulness and of the importance to receive it before too much spine damage occurs.”