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Multiple Myeloma Life Expectancy Prognosis Remains Stagnant for the Fourth Consecutive Year !   :(   What is Wrong???

4/26/2014

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If nothing changes, nothing changes!  Every year in April the National Cancer Institute updates their survival data for all cancers, and every year I have high expectations the numbers for the average life expectancy for multiple myeloma will show significant improvement.  And also in some small way I and my fellow advocates might have had a limited but important part to play in this success, and that our efforts would have some value to the myeloma patient community for this improvement in survival. 

But as is the case again this year, the average life expectancy remains at just 4 years. It has not improved at all for the last four years.  I had seen some progress in the 1st year survival and hoped this would translate into improvements in the two and three year survival the following year and it has, but only marginally.  The two and three year life expectancy improved by 6%.  The one year survival went down from 81.4% to 80.7%. To view the NCI myeloma survival table CLICK HERE.
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So is this another example of insanity as defined by Albert Einstein?  Do  we continue to do the same things year in and year out, and expect the different results?  On the surface I think not.  We do see a number of new drugs coming to market, myeloma specialists have survival rates 2 to 3 times the 4 year average,  Clinical Trials continue to identify new promising drugs like the monoclonal antibodies, and the continued and expanded efforts by patient advocates, doctors, IMF, MMRF, and LLS to improve awareness.  Or is what we are doing the definition of "FUTILITY"?    Futility is doing the wrong things over and over again and expecting different results. - Anonymous 


Everything which has been accomplished seems to be the right things, however if the results do not improve, I can only think we are not pushing the right buttons to improve results in a Revolutionary not Evolutionary manner.  Might we be missing the things which when accomplished would improve results in a Revolutionary way?  

Let us look at the history of other cancers to see what in fact has caused their Revolutionary improvements.

Breast Cancer:  Was it new drugs, new procedures, imaging, or breakthrough surgical methods that made such improvements?  No it was awareness of the need for self examination and mammograms, and the great promotional and awareness work of advocates like Susan Komen and Breast Cancer ads everywhere.

Colon Cancer:  It was the same thing here with advocates like Katie Couric, and improved awareness of the need for Colorectal Cancer Screening.  Screening has gone up significantly which should result in an excellent improvement in survival because polyps are removed before they become phase 3 or 4 colorectal cancer cases. The big news here is that the rate of new cases per 100,000 population has dropped by 34% from 58 to 38 per 100,000.  This represents 25,917 fewer colorectal cancer deaths each year.


I could go on, however we can learn from this success in other cancers.  The UK's National Health Service has noted that 20% of myeloma patients die in the first two months after diagnosis,  in the US one third of patients die in the first two years,  25% of patients are diagnosed more than 306 days after going to the family practitioner for the first time, the majority of patients are treated by a local hematologist/oncologist without a myeloma specialist as part of their treatment team, and in a study in the UK 97% of the population had never heard of multiple myeloma.  

What could be done?  I am no marketing expert, however it would seem we have a visibility issue.  No one knows we exist.  I often say you can not improve that which you do not measure, but maybe our biggest hurtle is that myeloma patients, family practitioners(GP's), oncologists, and the general population "Don't know what they don't know!" , and the general public and GP's will continue to not know until we find ways to get awareness up from 3% to more like 90%+.  We need a major "Public Service Myeloma Awareness Campaign."   I am coming to the belief that the numbers will not change until the general population and family practitioners know the symptoms, and oncologists know that they need a myeloma specialist on the treatment team.  Otherwise, unless something changes, nothing will change!  

Without a major Public Service Awareness Campaign our best approach is for EACH of us get this message out to our facebook, twitter or other social media contacts and give it to our family doctors.  You may not know someone with myeloma symptoms but your contacts might, and you may just help to SAVE LIFE!  Just Click the Twitter and Facebook icons at the end of this post. The United Kingdom's National Institue of Health  has put out a pamphlet for family doctors, just CLICK HERE.  World renowned myeloma specialist Dr. Edward A. Stadtmauer of the University of Pennsylvania has a web based educational program for general practitioners and it should be required reading  CLICK HERE.  

The Symptoms of Multiple Myeloma can include:
  • Bone pain and skeletal fractures, including compression fractures of the spine, which can cause severe pain, particularly in the back. A backache that lasts for months can be a signal that multiple myeloma is affecting bones in the spine and/or the ribs.
  • Frequent infections, especially bacterial infections of the respiratory and urinary tracts, which occur because the immune system is weakened.
  • Fatigue, weight loss, and general discomfort caused by anemia (insufficient red blood cells).
  • Nausea, vomiting, altered mental state, depression, and headache, caused by abnormally high calcium levels in the blood (hypercalcemia).
  • Loss of kidney function, leading to fatigue, buildup of fluid in the lower limbs, nausea, and vomiting.
  • Bruising, rashes, nosebleeds, vision loss, headache, dizziness, and peripheral neuropathy (numbness, tingling, and burning pain in the extremities) caused by blood that has thickened (a condition called hyperviscosity) due to high levels of protein.
  • Shooting pains in the arms and legs caused by a tumor in the spinal column pressing on nerves.

In about one-third of patients, multiple myeloma is detected before symptoms appear through routine blood tests that show elevated levels of immunoglobulin proteins.


Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1
 

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Thank You Dr. Bart Barlogie - You Have Been, and Will Continue to be Inspirational!

4/22/2014

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The rumors have been around for awhile.  Dr. Bart Barloge is 69 years old, well past retirement age, and rumored to be on his way to a leisurely retirement, to fly fish, vacation endlessly in Santorini, Greece, sky dive, swim with great white sharks, and ride a bucking bull named FU MAN CHU, etc.  But even when Bart retires he retires in place, and a letter explaining this follows.  However, I think Nick Van Dyk, a patient advocate, fellow Cure Panel member,  a patient and friend of Dr. Barlogie,  an ardent supporter of Total Therapy, said it best in his blog post. 

"My beloved doctor Bart Barlogie has led MIRT and UAMS since its inception, managing not just the clinical and research aspects but all of the administration of the center.  I've seen first-hand how hard the guy works -- 12 hour days 7 days a week are just the start of it.  He's never not thinking about his patients and this disease.

I'd been led to believe that he would be passing the torch -- partially at least -- as he confided in me some time ago that he's been looking for his successor.

Today, he has announced who it will be.  Bart will stay on in a clinical and research capacity, but the administrative "general manager" function will be handed off to Dr. Gareth Morgan, formerly head of the Myeloma unit at the Royal Marsden NHS Foundation Trust in the UK, and professor of hematology (or heamatology to those who speak The Queen's!) at the Institute of Cancer Research there.

I have mixed feelings about this, of course.  I'm glad to see my friend be able to slow down, and I'm heartened by the fact that he will continue his clinical practice and research activities.  However I also want to make sure he remains directing my care.  It's funny -- when I first got there, I learned of his passion for motorcycles and in giving him a book on the history of Ducati, I wrote in it that he's not allowed to get in a crash until he's cured me.  :)   No crashes that I know of, but he's also not allowed to retire until he's cured me, either!  : )"




The entire heartfelt post from Nick's blog can read if you CLICK HERE.

I, along with many of Bart's current patients, am just so thankful that he will remain at UAMS and we may continue to receive his exceptional care.  Dr. Barlogie has been one of the key figures in the center of the efforts to improve care, improve research, and treatment of multiple myeloma,  His treatment philosophies once considered radical and cutting edge, continue to be validated and incorporated in the front line treatment of the newly diagnosed.   This includes the use of stem cell transplant, Imids, Protesome Inhibitors,  Induction, Consolidation, and Maintenance therapy in first line treatment. 



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World-renowned multiple myeloma researcher and clinician Gareth Morgan, M.D., Ph.D., today was named director of the University of Arkansas for Medical Sciences (UAMS) Myeloma Institute for Research and Therapy (MIRT).
 
Morgan, who is currently a clinician and researcher with the Myeloma UK Research Centre at the Institute of Cancer Research in London, will begin at UAMS on a full-time basis in July. He is a director of Myeloma UK, a respected patient organization, as well as a member of the Scientific Board of the International Myeloma Foundation, Scientific Secretary for the UK Myeloma Forum and founding director of the European Myeloma Network.
 
Morgan succeeds Bart Barlogie, M.D., Ph.D., the institute’s founder who has chosen to step down as director but who will remain to focus on clinical care and research.
 
“I am thrilled to be taking up this new post and very much look forward to the opportunities it presents.” Morgan said. “With support from UAMS, I will build on the excellent work done to date as well as its reputation as world leader in myeloma treatment to develop innovative approaches for all myeloma patients and to characterize and cure high-risk myeloma.
 
“Myeloma is different for each individual patient, as different as one fingerprint is from another. It’s critical to develop technologies that can read this fingerprint, and to determine what is driving the disease in each individual patient, so we can kill or normalize the behavior of the myeloma cells. There isn’t a single treatment for myeloma but rather, there are many different, personalized treatment strategies, one of which is appropriate for a particular individual patient.”
 
Morgan said going forward, “We envision establishing a series of clinical trials investigating new treatments based on each patient’s unique myeloma fingerprint.”
 
“Gareth Morgan is an internationally recognized and respected scientist and clinician who works in the field of the molecular genetics and treatment of blood cell cancers — in particular, myeloma,” said UAMS Chancellor Dan Rahn, M.D. “The work he will do carries substantial promise of not only supplementing the research directions already being pursued within the institute, but in developing treatments with minimal toxicity.”
 
In support of the Myeloma Institute and Morgan’s recruitment, Gov. Mike Beebe has provided $5 million from General Improvement Funds. In a $3-for-every-$1 match, philanthropic contributions raised by UAMS have provided another $15 million for a total of $20 million. Goldman Sachs Philanthropy Fund, at the recommendation of Carol A. Ammon, chair of the Myeloma Institute Advisory Board, and her spouse Marie Pinizzotto, M.D., made the first matching gift of $5 million. The $20 million will help pay for the construction of new laboratories and the institute’s research program.
 
“As Governor, I am very pleased to provide funding to support the Myeloma Institute and Dr. Morgan’s research,” Gov. Mike Beebe said. “What has been built at the institute by Dr. Barlogie is truly remarkable and has enabled Arkansas to become a world leader in the research and treatment of multiple myeloma. With this funding and Dr. Morgan’s guidance, I’m confident the UAMS Myeloma Institute will continue pushing forward to fulfill its mission in innovative and dynamic ways.”
 
Morgan said he will align the expertise of the UAMS Myeloma Institute with other world-class research and treatment institutions around the world, especially with the Myeloma UK Research Centre at the Institute of Cancer Research in London. UAMS’ position as a leader for the treatment of myeloma will make it a central player in this global collaboration.
 
Barlogie, director of the UAMS myeloma program since 1989, is confident that Morgan is the right person to assume the reins and welcomes the opportunity for the two of them to work together.
 
“With a common vision and shared philosophical approach, Dr. Morgan and I can infuse the myeloma program with a forward-moving emphasis on utilizing research and technology to benefit patients,” Barlogie said. “By bringing together our collective experience, we will be optimally poised to implement the latest scientific and treatment advances, while maintaining a focus on each individual patient.”
 
Founded in 1989, the myeloma program at UAMS has seen more than 11,000 patients from every state in the United States and more than 50 foreign countries and has performed more than 9,000 peripheral blood stem cell transplants. Barlogie and his colleagues fundamentally have changed the course of the disease and its effects through new diagnostic procedures and novel therapeutic interventions.
 
 “We have excellent results leading to the cure of patients with myeloma. Now the major challenge relates to improving the clinical outcome of patients with genomically defined high-risk myeloma, a subtype of myeloma with a current median survival rate that does not exceed three years,” Barologie said. “Focusing research on this high-risk subtype of myeloma will also have strong implications for improving the outcomes of low-risk disease.”
 
The work Morgan proposes to develop is already in progress at the Myeloma Institute through the application of commercially available drugs that target unique oncogene mutations.
 
The expected five-year survival rate for a newly diagnosed myeloma patient treated at the UAMS Myeloma Institute is 74 percent, versus 43 percent for a comparable patient population in the NCI cancer statistics (SEER) data base. Newly diagnosed patients with genomically defined low-risk disease treated at the Myeloma Institute can expect a median survival exceeding10 years. Based on 25-year follow up of patients enrolled in the first “total therapy” clinical trial at the institute, a cure plateau of 15 percent has been firmly established.
 
Morgan holds more than $10 million of research grant funding from various governmental and private philanthropic sources.
 
“At the UAMS Myeloma Institute I envision conducting focused clinical studies investigating how to improve the current excellent clinical results obtained at the UAMS Myeloma Institute as well as investigating how such advances can be translated into wider populations by engaging in large phase-three studies including patients both in the United Kingdom and USA,” Morgan said.
 
Morgan received his doctorate on the genetics of leukemia from the University of London in 1991 and his bachelor of medicine in 1981 from the Welsh National School of Medicine. Since 2003, he has served as a professor of Hematology and director of the Centre for Myeloma Research at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research in London, Europe’s largest comprehensive cancer institute.  Morgan is a director of Myeloma UK, the UK’s respected patient organization, as well as a member of the Scientific Board of the International Myeloma Foundation and Scientific Secretary for the UK Myeloma Forum. He is also a founding director of the European Myeloma Network. 
 
To learn more, please myeloma.uams.edu. 

4301 W Markham | Little Rock, AR 72205 US




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Marijuana and  Myeloma - Who Would Have Thunk?

4/14/2014

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Sometimes truth is stranger than fiction.  Pat Killingsworth had a blog post titled, "Can Marijuana and Cialis really kill myeloma cells?" Well it is not fiction, but reality and you can listen to Dr. Donald Abrams, who is a cancer and integrative medicine specialist at the UCSF Osher Center for Integrative Medicine at Mount Zion.  He is also a vigorous supporter of using marijuana to help minimize a cancer patient’s side effects affectively and affordably, but has yet to see the hard data that supports efficacy against MM. 
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But does cannabis help fight cancer, too? If you click on the article title above you can see some data on the most recent research on this subject.  This Cure Panel broadcast was aired onApril 15 and you can listen to the rebroadcast if you CLICK HERE.  I had been knowledgeable of the fact cannabis was proven to be able to mitigate the nausea and discomfort caused by many therapeutic chemotherapy drugs.  However, what has recently been discovered is that cannibidiol (CBD), a non-psychoactive component of marijuana, had therapeutic value in multiple myeloma treatment.  After studying the effects of cannabidiol on multiple myeloma cells, researchers found that, “CBD by itself or in synergy with Bortezomib strongly inhibited growth, arrested cell cycle progression and induced MM cells death by regulating the ERK, AKT and NF-κB pathways with major effects in TRPV2+ cells.” They conclude that, “These data provide a rationale for using CBD to increase the activity of proteasome inhibitors in MM.”  Cannabis and Cialis, if it doesn't cure your myeloma you may just go out with a big SMILE on your face.  

Good luck and may God Bless your Cancer Journey or Trip.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1




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Is Finding the Key to the Treatment of High Risk Multiple Myeloma the Road to Cure for ALL MYELOMA?

4/11/2014

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Dr. Rafael Fonseca Discussed Progress in High Risk Multiple Myeloma on the April Myeloma Cure Panel broadcast.  Dr. Fonseca is the deputy director, Mayo Clinic Cancer Center, Getz Family Professor of Cancer and professor of medicine, Scottsdale, Arizona. To listen to a rebroadcast of the program CLICK HERE. To view a recent summary by Pat Killingsworth please CLICK HERE. More information on the program follows:


I remember reading an interview on high risk disease which featured Dr. Rafael Fonseca (Mayo, Scottsdale) and Dr. Bart Barlogie (UAMS, Little Rock).  During that presentation from 2007 these two doctors, arguably two of the most knowledgeable about high risk myeloma in the world, were perplexed at the lack of progress in high risk myeloma treatment.  To read this primer on high risk myeloma CLICK HERE. 
I believe these two myeloma specialists remain in the leadership position in the treatment of high risk myeloma.  In the six years since this presentation, there has been a lot of progress in overcoming high risk features.   
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The deletion of chromosome 13 is no longer considered high risk with the use of Velcade, and the 4:14 translocation is less high risk if Velcade is used in long term maintenance therapy. Gene Expression Profiling and the use of FISH tests have become more  widespread  as a measure of risk, and we now have Kyprolis and Pomalyst and the new monoclonal antibodies.  All of these have yet to be fully evaluated for their effectiveness in the treatment of high risk disease. 

So why is success with high risk disease mean so much to the future of survival of myeloma patients? Because as myeloma continues to be treated, its genetic profile changes and continues to take on more high risk features and becomes resistant or refractory to prior treatments.  Therefore most patients with long term continuous treatment will have high risk features which will be untreatable with current methods. So most patients other than those low risk patients who have chosen to go for the cure and make it to 10 years in CR, will be confronted with high risk features.  Dr. Fonseca is involved or is familiar with the most recent high risk clinical trial results, as well as data generated from 60 years of myeloma survival results from the Mayo Clinic's extensive data pool.  

Dr. Rafael Fonseca will be discused the progress being made in High Risk Multiple Myeloma Survival on April 14, 2014, 6:00 p.m. EST on the Myeloma Cure Panel broadcast.  Dr. Fonseca is the deputy director, Mayo Clinic Cancer Center, Getz Family Professor of Cancer and professor of medicine, Mayo Clinic College of Medicine, as well as site director, hematological malignancies, Mayo Clinic, Scottsdale, Arizona.  To listen to the rebroadcast CLICK HERE.

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Multiple Myeloma -  Who May Just Save Your Life?  It Is Your Family Doctor!

4/5/2014

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We know that 1 in 5  multiple myeloma patients die in the first 2 months, 1 in 4 in the first year, so what could possibly be the reason?  Usually a MM patient will have symptoms, which will send them to their family doctor.  So why on earth do patients end up going to a hematologist/oncologist with advanced stages of this disease? I do not think that it is lack of insurance, but mostly because the average age is 70 years old and most people will have Medicare, and now ACA (Affordable Care Act) will help those who are younger.  Could it be that some patients refuse to see a doctor until they have let their disease progress too far?  I hope not. This is the Macho or Martyr approach to health care.   So why do we continue to have the misdiagnosis, slow diagnosis, and lack of diagnosis?  The SAD fact is that the lack of knowledge about multiple myeloma is not only in the general population, but also in the front line of health care or the family practitioner.  
PictureOnly some family doctors get Myeloma right the first time!!
With 97% of people having never heard of Multiple Myeloma, it may leave us to think that the average Family Practice doctor may have little to no understanding of myeloma and its symptoms.  A recent article by the Lancet exposed this in detail.  

"A study, led by researchers at the University of Cambridge, found that patients with breast, melanoma, testicular and endometrial cancers are more likely to be referred to a specialist after just one or two consultations.   However, patients with some less common cancers such as multiple myeloma, pancreatic, stomach and ovarian cancer, as well as patients with lung and colon cancers and lymphomas are more likely to require three or more visits to their family doctor before they are referred to a hospital specialist. Patients with multiple myeloma, a blood cancer that is notoriously difficult to diagnose since it mimics many other conditions, are 18 times more likely to require three or more pre-referral consultations compared with patients with breast cancer." - To see more CLICK HERE.  


As far as how this can delay a diagnosis and make it a far more advanced disease is highlighted in an article in  BMC Hematology.  "The time from symptom onset to diagnosis  varied markedly by diagnosis: acute myeloid leukemia being 41 days (Interquartile range (IQR) 17–85), diffuse large B-cell lymphoma 98 days (IQR 53–192) and myeloma 163 days (IQR 84–306)." The interquartile range (IQR), also called the midspread or middle fifty, is a measure of statistical dispersion.  This means that the middle 50% of patients required between 84 and 306 days to diagnose from symptom onset, but it also tells me that 25% of patients are diagnosed more than 306 days after going to the family practitioner for the first time.  To view the entire article CLICK HERE.  This has not fallen on deaf ears, but not the right ears.  Lawyers are starting to see the possible malpractice money in this new information, and you can see an example if your CLICK HERE.

From the American Cancer Society web site I found a summary which may just help to educate the yet to be diagnosed and their familiy doctor..  It outlines the symptoms, a few of which are anemia, frequent infections, nerve tingling and damage, bleeding that will not stop, bone breaks in the spine and ribs, confusion, and kidney damage.  A standard blood test can be an indicator of possible trouble, even if you show no symptoms.  Low red blood cell count, low platelets, high calcium, low white blood cell counts, excess protein in the blood, and more depending on the number of variables tested.  A better more extensive list of symptoms and the many diagnostic tests are available at the American Cancer Society site which you can read if you CLICK HERE. So we know what tests and measurements should be red flags for your family doctor to pursue additional testing or recommend seeing a hematologist/oncologist.  

Because the above data is average, there are some family doctors who outperform these averages.  My family doctor is  Dr. Arnold Fong of Ponte Vedra Beach, FL,  and based on this published data, I owe him my life.  He was an exceptional exception and had me diagnosed in just 7 days.  Thank You Dr. Fong, and I hope that everyone can find their Dr. Fong.

We need to get this information out to the general public and to your family doctor. One way for YOU to help with Myeloma awareness is by getting this message out to your facebook, twitter or other social media contacts and give it to your family doctor.  You may not know someone with myeloma symptoms but your contacts might, and you may just help to SAVE LIFE!  Just Click the Twitter and Facebook icons at the end of this post. The United Kingdom's National Institue of Health  has put out a pamphlet for family doctors, just CLICK HERE.

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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    Gary R. Petersen
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    CLICK HERE for my myeloma journey

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