When Lorelei Dalrymple was diagnosed with multiple myeloma, she was relieved.
It was 2009, and she had spent the last four years living with fatigue, headaches and the intermittent loss of feeling in her limbs. Various rounds of tests had all come back with inconclusive results.
It wasn’t until she repeated yet another round of blood work that something suspicious showed up. After a hematologist ordered a PET scan, it was confirmed: Dalrymple had multiple myeloma, a cancer affecting the plasma cells (a subset of white blood cells) in the bone marrow (the precursor “multiple” comes from the fact that there are many different types of myeloma). But the diagnosis didn’t scare her because it meant she knew what she was up against. “There’s nothing worse than not knowing what’s going on,” she says. The next six months were a whirlwind, as she underwent induction therapy to try to reduce the load before a stem cell harvest and transplant that would lead to a three-and-a-half year remission.
Until recently, multiple myeloma prognoses were grim. Even as little as five years ago, the life expectancy from date of diagnosis was just two to five years. Now, it’s up to eight to 10 years, with many patients living longer than that.
Dalrymple knew the cancer would come back: that’s just the way myeloma works. Her blood work had shown slowly increasing myeloma protein levels, and she started to develop hip pain that got so severe that she couldn’t lift her leg. Her remission officially ended last fall, after an MRI confirmed lesions in her pelvis. She went back into a new course of treatment with radiation and new drugs that she takes daily.
Dr. Christopher Venner, clinical lead for the Malignant Hematology Program at the Cross Cancer Institute in Edmonton and assistant hematology professor at the University of Alberta, says part of the difficulty in treating multiple myeloma is its ability to adapt to treatment. “Because it’s genetically unstable, it figures out ways of evolving around our therapies,” he says. “Management really revolves around the principle of trying to stay one step ahead of it.”
But advances are happening quickly in both knowledge of the disease and expanding options for treatment. One of the treatments Venner is excited about is engineered antibodies. Using the same approach as vaccines – our bodies create antibodies to fight the diseases we’re being vaccinated for – an engineered cancer-fighting antibody would hone in on a specific marker in the cancer cell, targeting that cell and leaving healthy, non-cancerous cells alone. This type of treatment already exists for lymphoma, but Venner says it’s taken a long time to develop a myeloma-specific form of it.
Our understanding of genetics is also leading to a greater understanding of myeloma. The Human Genome Project, which sequenced all the DNA in the human body, was completed in 2003 after more than a decade of work.
Now, says Venner, we can run a whole genome – comprised of millions of genes – in a week for under $1,000, and we can even do some of that work in Alberta. DNA mapping helps with myeloma because it paints a very detailed picture of what is going on in the cancer cells. “You can sequence all the DNA in a malignancy to see what genes have changed, what genes are overactive or underactive,” he says, noting that DNA changes are what causes cancer in the first place.
The “holy grail,” says Venner, is to be able to pinpoint the “driver mutations,” multiple DNA changes that can cause myeloma, and to try to find a drug to turn that off. He says that’s the goal for all cancers, not just myeloma.
A province-wide clinical database, created with funding from the Alberta Cancer Foundation, is another important advancement. A database that tracks patient treatment and outcomes is “the only way you can see whether what you’re doing is working,” says Venner. It is also crucial to put the laboratory findings into perspective, “making the discoveries relevant to the patients sitting in front of us.” Before the online database, a doctor would have to sift through paper copies of charts of other patients to see if a particular drug or combination had been attempted before. It’s the first of its kind for myeloma in Alberta and will complement other national and international initiatives. While it may be ambitious, the ultimate goal is to develop a comprehensive disease-specific database used by all interested researchers and clinicians across the country. Venner says that, “Given the interested and experienced core group of people in Alberta, we are poised to be leaders here.”
So far, everything looks good for Dalrymple. Her cancer is back in remission and she’s taking oral chemotherapy every day. She knows her remission is temporary, but she’s confident that by the time the myeloma protein level starts to rise in her blood, there will be a new treatment that will hold the cancer at bay – or maybe even cure it .