Treatment

There is a dedicated consultant-delivered Myeloma Service at St. James’s Hospital.

Diagnosis

All patients referred with possible symptomatic myeloma will be seen within two weeks. General practitioners are welcome to call directly to discuss patients about whom they are concerned.

Early investigations include laboratory tests, a bone marrow extraction and biopsy and a whole body MRI scan. Cytogenetic analysis (referring to the study of the structure and function of the cell) is performed at diagnosis in all patients. There is a dedicated Myeloma Multi-Disciplinary Team (MDT) Meeting at which newly diagnosed patients are discussed and risk-modified treatment pathways are chosen.

Most patients diagnosed with myeloma will not need to be admitted to hospital. All investigations and treatment can be done on a day-ward setting.

Treatment

Most treatment protocols consist of a combination of several drugs, which work together to kill myeloma cells. Some, such as corticosteroids or immunomodulatory drugs, are tablets that will be prescribed by your doctor and filled out at your own pharmacy. Others are given either intravenously (into the vein) or subcutaneously (injected into the skin) by specialist nursing staff on our day ward. Our clinical nurse specialist will be able to talk you through all of these issues.

The first few months of treatment often involve weekly visits to the day ward and a monthly review with the consultant. Treatment is provided by experienced nursing staff on the Haematology Oncology Day Ward. Nurse-led clinics are held for both the administration of chemotherapy and of bone-strengthening agents such as Zometa. Patients attend the Myeloma Clinic on Thursday mornings for routine medical review.

Younger patients who may be eligible for an autologous stem cell transplant (the transplant of their own healthy cells) can have a three-week admission to hospital. This does not happen at diagnosis, but is generally discussed as an option after four months of ‘induction’ chemotherapy. There is a dedicated Myeloma Transplant Counselling Clinic at which all relevant issues are discussed in detail so that patients can make an informed decision as to whether they wish to pursue this treatment.

Those patients for whom autologous transplantation is deemed appropriate are admitted to Denis Burkitt Ward, the inpatient facility for the National Adult Stem Cell Transplant Centre. The centre performed 45 autologous transplants for myeloma in 2013.

Clinical Trials

We encourage patients to enroll in clinical trials and are supported by an active Clinical Trials Unit. This ensures that patients have early access to new treatments that may not yet be licensed for routine use.