In a healthy body, plasma cells found in the bone marrow produce antibodies that are crucial for combating infections. But when multiple myeloma strikes, malignant plasma cells multiply rapidly, displacing healthy cells and disrupting their normal function.
According to Dr Chen Yunxin, senior consultant haematologist at Singapore General Hospital and National Cancer Centre Singapore, multiple myeloma can impact various parts of the body. Its symptoms are wide-ranging, which makes the disease harder to recognise and treat. Some patients show no symptoms, while others may experience bone pain or weak bones, anaemia leading to fatigue and difficulty breathing, unexplained fevers, recurrent infections and kidney damage.
Despite the availability of effective treatment options, myeloma cells can become resistant to treatment and acquire new genetic mutations over time, resulting in a continuous cycle of remission and relapse. However, with newer treatments available, patients with multiple myeloma may see improvements in the prognosis of their condition.
Dr Chen noted that a wait-and-see approach may be adopted for early-stage multiple myeloma, also known as smouldering multiple myeloma, with close monitoring through regular check-ups. For most other patients, the three main treatments typically prescribed are targeted therapy, immunotherapy and chemotherapy. “As symptoms vary from patient to patient, recommending a treatment plan involves striking a delicate balance: Effectively controlling the disease while minimising side effects,” she said.
As a result, each patient follows a unique treatment pathway, potentially undergoing multiple treatment regimens throughout their illness.
According to Dr Chen, challenges emerge when patients experience recurrent relapses that tend to escalate with each instance, shortening the remission periods. Relapse occurs when cancerous cells that have survived treatment continue to multiply in the body, becoming more aggressive with each new line of therapy attempted.
Ms Wong’s initial treatment plan included multiple rounds of chemotherapy and a stem cell transplant, neither of which provided sustained remission in her case. She remained in pain and found it difficult to walk.
“Despite significant scientific advancements, patients who develop relapsed and refractory (resistant to treatment) multiple myeloma after exposure to the three main forms of treatment have limited options and generally face poor outcomes,” said Dr Chen.
She estimated that patients typically undergo four or more lines of therapy, with diminishing responses to each subsequent treatment. Up to 50 per cent of patients with advanced or high-risk multiple myeloma experience relapse in less than three years and less than 30 per cent survive more than five years.
In Ms Wong’s case, she began to see improvement in her health only after starting her third line of treatment, which utilised varying treatment options available for multiple myeloma.
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