Jessica Skarzynski

Each month, we take a look back at the most popular CURE® stories. Here are the top five stories for May 2021.

Clinical trials are often the key to advancements in 

. As part of its “Speaking Out” video series, CURE® spoke with Dr. Debra Richardson about what patients should know about joining a trial.

4. Our Microbiome: A Reflection of Ourselves?

Sophisticated analyses can predict which 

 may lead to better outcomes to immunotherapy for patients with advanced melanoma.

3. Is Your Life Being Run by Cancer or Are You Running Your Life?

A cancer survivor explains how she prevents an 

 of doctor appointments from spoiling her appreciation for life.

2. Sugar-Filled Drinks Could Be Cause for Alarm After a Breast Cancer Diagnosis

higher consumption of sugar-sweetened beverages

 can be associated with a higher risk of breast-cancer specific mortality and death from all causes, according to data published in 

1. Doctor’s Experience as a Cancer Caregiver Is Helping Educate Others

 who has spent her career helping patients during their cancer journeys goes a step further to educate women on how to advocate for themselves and possibly prevent cancer before it occurs.

For more news on cancer updates, research and education, don’t forget to 

Articles

CURE’s Top Stories: May 2021

To learn about how multiple myeloma can develop, it’s important to first learn about a plasma cell disorder called monoclonal gammopathy of undetermined significance (MGUS). But how is MGUS treated, if at all, and how does it become myeloma? That’s what Dr. Manisha Bhutani, an associate professor at Levine Cancer Institute in Charlotte, North Carolina, set out to explore during her session at CURE

’s Educated Patient Summit on Multiple Myeloma.

“This precursor condition happens long before the diagnosis of multiple myeloma, and oftentimes, it goes undiagnosed,” Bhutani said. It is estimated that MGUS affects roughly 3% of people older than 50, and 9% of individuals over 80, but as Bhutani noted: “It’s really important to remember that a small proportion of patients with MGUS will ever progress to multiple myeloma. However, all patients with multiple myeloma once had MGUS.”

To highlight this, Bhutani mentioned a 2009 study that looked at the stored annual bloodwork of more than 77,000 cancer-free men and women and found that of the 71 individuals from this group who later developed multiple myeloma, MGUS was detected in all 71 cases, proving that MGUS always comes before multiple myeloma.

While there are no clear causes, Bhutani noted that there are certain factors that increase the risk of developing MGUS, including being older, having a family history of MGUS and/or myeloma, having immunosuppression, being Black or African American, being male, and having exposure to certain environmental hazards and radiation.

MGUS is a disorder of a certain type of B cells, or white blood cells found in the bone marrow. In a healthy individual, Bhutani explained, these plasma cells produce antibodies of different types called polyclonal immunoglobulins, which help fight infections against viruses, bacteria, and other microorganisms. But in MGUS, these antibodies undergo genetic changes and are considered abnormal, then expand to make a monoclonal plasma cell population. These then produce just one kind of antibody called a monoclonal antibody (or M protein), as opposed to the various proteins that healthy cells normally produce.

Additionally, there are changes happening within a patient’s bone marrow microenvironment and immune system as the disease progresses from MGUS to smoldering multiple myeloma (SMM).

Diagnoses of MGUS are often made by chance, Bhutani explained, during investigation of other possible disorders using serum protein electrophoresis (SPEP), immunofixation (IFE) or free light chain assay (FLC) tests. And while mass spectrometry is a more sensitive method that can detect levels of monoclonal proteins at an even lower level in the blood, not every lab can perform this type of test, though Bhutani noted that in the coming years, she believes it may become a new standard.

Within MGUS, there are several subtypes of the disorder, Bhutani explained. Non-IgM MGUS accounts for 85% of cases and may progress to myeloma or solitary plasmacytoma or amyloid light-chain (AL) amyloidosis. IgM MGUS, which is more lymphoplasmacytic in nature, often progresses to Waldenstrom macroglobulinemia, or non-Hodgkin lymphoma, rarely to amyloidosis, and very rarely to IgM multiple myeloma. The final subtype, light-chain MGUS, may progress to a specific type of myeloma called free light chain multiple myeloma.

Bhutani discussed the rate of progression to smoldering multiple myeloma (SMM), the next step in progression to full multiple myeloma, and again stressed that not everyone with MGUS will progress. “In fact, only 20% of subjects over a period of 20 years would progress at a rate of 1% per year,” she explained. “And we don't precisely know exactly who is going to progress and at what time.”

There are certain risk factors at diagnosis that have been shown to impact the rate of progression, however, including having an M protein rate of ≥ 1.5g/dL, being diagnosed with non-IgG MGUS, or having an FLC ratio of <0.26 or >1.65. When an individual has none of these risk factors, the rate of progression is generally around 5%, but that rate increases to 21% with one risk factor, 37% with two factors, and goes up to 58% when someone has all three risk factors.

MGUS can lead to other complications, including renal disease, an increased incidence of infections or bone fractures, osteoporosis, and neuropathy, Bhutani noted.

Bhutani explained that treatment of MGUS is not necessary unless a patient wishes to participate in a clinical trial, as there is currently no evidence that early treatment will improve outcomes.

MGUS will sometimes develop into SMM, Bhutani explained, which is diagnosed when certain criteria used to diagnose MGUS are exceeded. “This is an intermediate condition which is sandwiched between MGUS on one side and multiple myeloma on the other side,” she said. Citing data from the Mayo Clinic, Bhutani noted that the risk of progression from SMM to multiple myeloma is approximately 10% per year for the first five years, and then drops to 3% per year for the next five years. Beyond 10 years, the risk drops to around 1%, the same for a patient with MGUS.

There are two approaches for dealing with SMM, Bhutani said: preventive and curative. With a preventive approach, doctors simply try to prevent or delay the progression of SMM into clinically symptomatic disease, while those who opt for a curative philosophy believe that using all the different, more powerful therapies in the current treatment arsenal that is being examined in clinical trials right now, the disease can potentially be eradicated, or myeloma could even be cured.

Currently, the standard of care for SMM is similar to MGUS in that it involves periodic follow-up and monitoring. Individuals with low- or intermediate-risk disease do not need treatment unless they opt to participate in a clinical trial, while those with high-risk SMM are encouraged to participate in trials.

To conclude, Bhutani noted, there is some unpredictability about whether SMM will behave like MGUS or like early stage multiple myeloma, which raises a debate about whether SMM should even be considered a condition in the first place. “We know that definitions are changing,” she said.

“We're becoming more and more precise in defining the biomarkers that define progression,” Bhutani said. “And we ultimately hope that we’ll have a composite risk score based on disease burden, genomics, and immunologic criteria that will refine this disease definition such that there is MGUS that gets observed, and active multiple myeloma that gets definitive treatment, with nothing in between.”

All patients with multiple myeloma have had MGUS, so what is it?

How a Plasma Cell Disorder Called MGUS Can Progress to Multiple Myeloma

To honor Bladder Cancer Awareness Month this May, 

 is taking a look at some of the most recent updates in the disease space.

 Talks Cancer” podcast, we spoke with a cancer research writer, 

, about his experiences writing a book about his late wife’s cancer journey and offers advice for other caregivers.

In April, the Food and Drug Administration (FDA) granted accelerated approval to Trodelvy (sacituzumab govitecan-hziy) for patients with 

locally advanced or metastatic urothelial cancer

, who have previously received platinum chemotherapy and either a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor.

Overall survival and progression-free survival did not significantly differ when adjusting the dose of 

 (paclitaxel protein-bound) and gemcitabine in patients with advanced/metastatic urothelial carcinoma, according to a study published in 

 for the treatment of patients with locally advanced or metastatic urothelial carcinoma whose disease progressed during or after platinum-based chemotherapy was pulled by the FDA and the drug’s manufacturer, Roche.

While it is important to educate oneself after receiving a diagnosis of cancer, it’s also critical to know when to step away and find a balance between cancer and life, according to Diane Zipursky-Quale, co-founder of the 

For more news on cancer updates, research and education, don’t forget to

A roundup of some of CURE®’s latest news and updates for patients with bladder cancer in honor of Bladder Cancer Awareness Month this May.

News and Updates for Bladder Cancer Awareness Month

Patients being treated for hematologic malignancies at City of Hope National Medical Center in Duarte, California took “dramatically” more steps each day after a walking program was implemented there, according to study results presented at the recent 2021 Oncology Nursing Society (ONS) Annual Congress.

City of Hope nurses recognized that patients did not walk as much during their hospitalization. The number of falls also increased and documentation of ambulation in electronic medical records decreased, prompting presenter Kimberly Mercado and her colleagues to create and implement a walking program for patients to increase ambulation and decrease falls.

“We really wanted to give them a program that would help them to get motivated to exercise on the unit and kind of get out of their rooms and keep up their stamina while they're receiving this treatment. Because as we all know, these treatments can be quite debilitating as in especially during COVID,” Mercado said during her poster presentation. “When the visitor policies don't allow for very many visitors, we wanted to make sure they had something to look forward to during their day and kind of get out and move.”

Mercado also noted that a walking program could potentially be beneficial to patients suffering from cancer-related fatigue, as exercise had been previously shown to improve this side effect.

To kick off the program, Mercado and her team created a brochure that explained the program to newly admitted patients and hung motivational posters throughout the unit to help keep patients interested in walking.

Foot-shaped charms were also given out as incentives that patients earned as they achieved each milestone. “Anytime a patient walked a lap, they could get a foot charm and hang it on their IV pole on a little chain to kind of remind them how much they've walked,” Mercado explained, “And it became nice for them to collect and understand just how well they were doing.”

“Another incentive we gave was a reusable City of Hope mask that if anybody walked to 5K (3.1 miles) while they were on the unit, they would be given this to take home with them,” Mercado added.

A staff education component was implemented through emails, flyers, and in meetings, with the goal of explaining the program and offering tips how to encourage patients to participate.

Before the program, patients walked an average of 136 steps in a 24-hour period. A few weeks after implementation, that number jumped to an average of 847 steps, and further increased to an average 1,018 steps per day at the end of one month.

Although fall data is still being collected, the number of patient falls decreased from six in Q1 of 2020 to four in Q1 of 2021. Additionally, the number of falls with injury was zero, compared to one in 2020. To Mercado and her colleagues, this data, coupled with the dramatic increase in daily steps, signaled a success. “Patients seem to really take to it and enjoy it as well,” she noted.

“As we go along, we obviously want to keep doing this program on our floor. Maybe it could even go house-wide at some time,” she said.

In addition to evaluating fall data, going forward, Mercado concluded that she and her colleagues plan to gather patient feedback to further improve upon the walking program and add additional incentives such as challenge coins, pins, and patches for completing milestones such as distances of 10 kilometers (6.2 miles), a half marathon (13.1 miles) or even marathons (26.2 miles).

“If you can walk a marathon while you're getting cancer treatment, that's incredible,” Mercado said.

Prior to the program, patients with hematologic cancers walked an average of 136 steps in a 24-hour period. One month after the program began, that total increased to an average of 1,018 steps per day.

Jessica Skarzynski

CURE’s Top Stories: May 2021

How a Plasma Cell Disorder Called MGUS Can Progress to Multiple Myeloma

News and Updates for Bladder Cancer Awareness Month

Patients with Hematologic Cancers Benefit from a Walking Program

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