 What are hematologic malignancies? Hematologic malignancies are essentially types of blood disorders, mainly cancers, including lymphomas, leukemias, or multiple myeloma. And these are cancers of cells that are either part of the blood or part of the immune system and typically grow either in the bone marrow, which is the part inside of bone, the liver, the spleen, or the lymph nodes, which are also part of the immune system. What is multiple myeloma? Multiple myeloma is a type of blood cancer, and it's a cancer of a particular cell in the body called a plasma cell. This cell is normally a helpful cell in the body because it helps produce a type of protein called an antibody that helps fight infection. In multiple myeloma, these plasma cells start to divide in clones and grow inside of the bone marrow where they normally reside, and in doing so, they produce a protein, an antibody protein that's also clonal, and this is how the disease is typically detected initially. What are the symptoms of multiple myeloma? That's a great question because the symptoms can really vary across the board. The most common presenting symptom is anemia, and that can make a person feel tired or fatigued or weaker than usual, maybe have a hard time climbing stairs. The other symptoms can include pain, for example, from a skeletal bone lesion, and that can cause back pain or bone pain in any area of the body. This may also have high calcium levels that can cause abdominal pain or change in bowel habits, but the best thing to do if you're having any sort of persistent symptom, such as one of the ones I listed, is to really see a primary care doctor and start the work up with some basic blood tests. What can cause multiple myeloma, and can it be inherited? Most of the time, we don't know what causes multiple myeloma, and in fact, the origin of the disease generally remains unknown, although there are some associations. For example, in our area, people who were first responders in 9-11 seemed to have an increased risk of the precursor to multiple myeloma, which is something called MGUS. There does seem to be a slightly increased risk among first-degree relatives, although we don't have a screening test because the overall incidence of multiple myeloma is low. How do you diagnose multiple myeloma? Is there a screening test? To diagnose multiple myeloma, it really requires a consultation with a hematologic oncologist, and a diagnosis is made by a combination of blood and urine studies, as well as skeletal imaging to look for any bone lesions. In addition, a bone marrow biopsy is required for the diagnosis, since this is a cancer of cells that normally reside inside the bone marrow, and that's where we perform the biopsy. Are there different stages of multiple myeloma? This is an important question that I often get asked by patients, because the staging of blood cancers is different from how we think about the staging of solid tumors, where there are typically four stages. In multiple myeloma, we only have three stages, one, two, and three. The higher stage being the slightly worse prognosis, and the staging is determined by a series of blood markers, as well as the genetics of the multiple myeloma that's ascertained during the bone marrow biopsy. And based on that, we can subgroup patients into one of those three stages and determine the best treatment. With today's modern anti-myeloma drugs, almost all patients in any stage are expected to have a good response. How is multiple myeloma treated? Is it curable? That's a great question, because we've made tremendous progress over the past decade developing new agents to treat multiple myeloma, so much so that the average survival of a patient with myeloma has doubled over the past decade. Now, because we have multiple options to treat multiple myeloma, we really have to tailor our therapy to individuals and individual patients. In general, multiple myeloma is considered to be incurable, but highly treatable, such that patients can live for many years similar to having a chronic disease. Do all patients with multiple myeloma require treatment? When we talk about multiple myeloma, in general, we're really talking about symptomatic multiple myeloma. And those patients really do require treatment in order to prevent worsening organ function. But there are two asymptomatic states that are called MGUS and smoldering myeloma patients. These are people who have an increased number of plasma cells in their bone marrow but haven't really developed organ dysfunction, such as bone lesions, for example. And these patients we typically monitor. There are some scenarios of patients with smoldering myeloma who are what we call higher risk for progression to multiple myeloma. And these patients we may initiate treatment in the context of a clinical trial. But in general, we just follow patients with MGUS and smoldering myeloma closely. And if we see any changes in their organ function, we would initiate treatment at that time. What is the role of stem cell transplant in multiple myeloma? Stem cell transplantation is used as part of the treatment for multiple myeloma. In fact, the number one indication for stem cell transplantation in the U.S. is for multiple myeloma. So when we're treating patients with multiple myeloma, initially we'll first determine whether a patient is fit to undergo stem cell transplantation. So initially they will receive what we call induction or initial chemotherapy to treat the disease, and then we will decide if they're a candidate for consolidating the disease with a stem cell transplant. There are two types of stem cell transplantation. One is called autologous transplant, and that's where your stem cells have been collected and frozen and then given back as a transfusion after a high dose of chemotherapy. And the purpose of that is to rescue the bone marrow from the toxic effects of the chemotherapy. An allogeneic transplant is where the stem cells are coming from a donor, and that in general is considered to have more side effects in multiple myeloma and is generally only done in the context of a clinical trial or patients who have not responded to an autologous stem cell transplant. Can you tell me about the comprehensive care team at NYU Winthrop? That's a great question because when patients initially see me in consultation, I'm seeing them individually, but they are actually working with the whole team behind the scenes who help support their care. So in our practice, we work with nurse practitioners, infusion nurses, dietitians, social workers, workers who deal with insurance authorization, and so this team comes together and meets weekly to determine the best care plan for each individual patient, and they also help address all the issues that may come up along the course of their treatment. What are some of the new developments on the horizon for multiple myeloma? There's a lot of excitement in the field of multiple myeloma because we really are making tremendous progress, both in understanding the biology of the disease and then using that information in order to tailor treatment to each individual patient's biology. So the first major advancement in multiple myeloma is using targeted therapy, specifically targeted to the multiple myeloma cells in the bone marrow, and this is with drugs called monoclonal antibodies. These are like heat-seeking missiles that go out and attack the myeloma, and research now that we are actually involved in is using these drugs up front for the treatment of multiple myeloma. Currently, they're only approved in patients who have failed initial therapy. Can you tell me more about multiple myeloma research at NYU Winthrop? Here at NYU Winthrop, research is really a critical component of the work we do. So we have two components to our research organization. One is clinical trials, which are developing the latest treatments to improve the care of the multiple myeloma patient, and that involves novel clinical trials that use agents that have not previously been used in multiple myeloma or previously been used but not in a particular setting, such as for the upfront treatment of multiple myeloma. The other component of our research is exploring the biology of multiple myeloma so that we can later develop new treatment targets. One of the research projects that I'm leading here at NYU Winthrop is looking at the role of the gut microbiome in multiple myeloma because this has been largely unexplored in this condition. Gut microbiome involves the living organisms that are in our bodies, such as the bacteria that live in our gut, and we're looking at this in multiple myeloma patients because multiple myeloma is a cancer of the immune system, and normally the immune system has to regulate which bacteria are healthy and which are harmful. So we're looking at how patients with newly diagnosed multiple myeloma, as well as its precursor phases, differs in terms of their gut flora and their gut microbiome. How is the relationship with NYU Langone enhancing the care of patients with hematologic malignancies at NYU Winthrop? Here at NYU Winthrop, we're all very excited about the relationship with NYU Langone. This will give us an opportunity to further collaborate with colleagues and other oncologists throughout the NYU Langone health system and potentially even share patients who may go for part of their therapy in Manhattan for a clinical trial, for example, and then return for their follow-up care here at NYU Winthrop and vice versa. So we're all very excited because this will enhance the already high quality of care we have at NYU Winthrop and allow us to collaborate with an even greater group of oncologists. For more information about the hematologic malignancies program at NYU Winthrop, call 866 WINTHROP or visit us online at NYUWINTHROP.ORG.