When bone marrow goes bad

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Sagar Lonial, MD:
When bone marrow goes bad

Healthy plasma cells, which live in the bone marrow, make antibodies that protect us from antigens like bacteria and viruses. But if those plasma cells become unhealthy; that is, if they grow unchecked, that unchecked growth leads to multiple myeloma.

Multiple myeloma is a type of cancer that results in lytic bone disease, or holes in the bones. What’s more, the malignant cells crowd out normal bone marrow resulting in anemia or a low white count, leaving a person vulnerable to infections.

Sagar Lonial, MD, an oncologist at Winship Cancer Institute, Emory University, treats people with multiple myeloma. Although the prognosis for people with this cancer is poor, progress is being made. Twenty years ago, the survival rate was two to three years, it’s now four to five. One of the keys to some patients’ longevity, says Lonial, is increasing enrollment in clinical trials and access to life-extending drugs.

Lonial and his colleagues are focusing on combining new drugs and noting the order in which the drugs are delivered to patients. “It turns out the sequence of administration may be very important because you may block the effect of a second drug if the first drug is given out of order,” says Lonial. “So, if you give drugs A and B together what happens if you give drug A first or give drug B first.”

With drug order in mind, researchers are also interested in identifying new targets in myeloma--targets that may not be broadly represented in all patients. “What we have to get away from is the idea that myeloma is a single disease,” says Lonial.

“It’s not a single disease. There are probably seven or eight genetic subsets of myeloma,” Lonial says. “What I think you’ve seen in all of oncology is a revolution on both sides of the equation. We now understand the specifics of cancer better, and we have more tools with which to attack that cancer.”

To hear Lonial’s own words about multiple myeloma and new ways to treat it, use the player at the top of this page or subscribe to the podcast.