Multiple Myeloma

From the Physician’s Desk 
. . .an Interview with Dr. James O. Armitage, MD

Receiving a myeloma diagnosis is overwhelming. You suddenly find yourself relying on a doctor you likely just met to help you understand a disease you know nothing about. Dr. Armitage is a leading oncologist and hematologist at the University of Nebraska Medical Center. He has extensive experience treating patients with myeloma, and he understands how important it is for patients to learn about their diagnosis and feel comfortable with their physician and the path ahead. Below he reflects on his approach to caring for newly diagnosed myeloma patients and offers his thoughts on the exciting treatment advances on the horizon.

Dr. Armitage found his passion for being in the cancer field as a medical student. While working in a lab, he realized he liked the challenge of hematology and eventually pursued a Hematology/Oncology fellowship. His focus leaned mostly to oncology, and he found his strength in taking care of people in difficult situations.

“In the beginning, I worked mostly with patients who had acute leukemia. I enjoyed treating them and making friends with them. At that time, however,” he explained, “we didn’t have as many good treatments for leukemia. Consequently, many of those patients passed away.”

While developing and directing bone marrow transplant centers at the University of Iowa and the University of Nebraska, he treated patients with myeloma and lymphoma. When he sat down with people who were newly diagnosed, he’d start by explaining the disease. He also assured them they didn’t do anything to bring it on.

“We still don’t know what causes myeloma,” he explained, “and I didn’t want them to feel guilty or feel like they should have done something differently.”

Because a myeloma patient has active disease and needs treatment immediately to relieve discomfort, making a treatment plan was the next step. He highlighted the considerable amount of progress made in treating myeloma.

“Myeloma used to be a terrible disease to have because of the lack of treatments available. The dramatic changes over the years have brought about equally dramatic improvements in making patients feel better by alleviating symptoms and side effects, along with helping people live longer. Today, it’s even more exciting because there are more advances on the horizon. ”

Depending on the patient’s unique diagnosis, treatment history and overall health, treatment might include an autologous stem cell transplantation or maintenance therapy, or both. Or, a younger patient might be a candidate for an allogeneic transplant.

“I used my expertise to recommend the treatment that I felt would work best for that patient. We would then talk about the potential side effects associated with the different types of treatment.”

If the patient met the criteria for a clinical trial that was testing new agents, Dr. Armitage always presented that as an option as well. He began by educating them about clinical trials.

“People are sometimes wary of participating in a clinical trial because they don't know much about them. I explain that a trial consists of the standard of care treatment and/or a new treatment that may be better. I also explain that their participation will help make life better for people in the future.”

Today, many clinical trials are taking place that will continue to change the face of mulitple myeloma treatment, including CAR T-cell therapy, an innovative treatment that re-engineers a patient’s own T-cells to attack cancer cells.

“CAR T-cell therapy is approved for a couple of blood cancers now, and it’s exciting to think it may have a place in the future of myeloma treatment.”

Dr. Armitage recognizes that physicians are unique in that they get to know people at their very best and, sometimes, at their very worst. As he shares information with patients throughout diagnosis and treatment, his approach is always to be hopeful and help his patients be hopeful.

“I tell them the truth,” he said. “Some people are cured of this disease, and there is a subset that could live for a very long time. Most people do really well, and I suggest we take the approach that they are going to be one of those people.”


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