69 yr old woman suffering from multiple Myeloma with four relapses let life triumph over adversity with personalized and holistic approach at Aster RV Hospital

A diagnosis of cancer is more often than not a sentinel event in someone’s lifetime. There are several challenges to be faced in such an event like choosing the right treatment, dealing with side effects, absence from social life, financial constraints and family issues including challenges for the caregivers. The most important risk factor for getting cancer is age and most patients in any oncologist’s OPD belong to the elderly population. The management of cancer does not stop at just giving chemotherapy. Incorporation of latest diagnostic and treatment modalities along with a more holistic approach for all round wellbeing is needed.

Mrs Prathiba (name Changed) 69-year-old lady was diagnosed with a type of blood cancer called Multiple Myeloma in 2014. Multiple Myeloma is a disease with a unique set of challenges like exacerbation of age-related bone degeneration, weakness due to low blood haemoglobin levels and kidney dysfunction. She was initially treated with a combination of chemotherapy and targeted therapies which got the disease into remission. Patient underwent an autologous bone marrow transplantation in 2015 at a private hospital in Bangalore and got back to leading her day to day life. After 3 years of leading a regular life, she suffered a disease relapse in 2018. However, with time, the armamentarium of drugs for treating this cancer had grown manifold and she was started on a different set of targeted agents which got her disease back in control. She returned back to her routine and continued to have a reasonable quality of life till early 2019.

In April 2019, patient had a 3^rd relapse and this time she became very sick due to severe kidney damage, low haemoglobin, platelet levels requiring ICU and nephrology support. The nephrologist at Aster RV hospital recommended dialysis support and with the support of the intensive care team she was stabilised. Just when it seemed that she was turning the corner, she developed bleeding from her gastro-intestinal tract. The gastroenterology team was involved and after endoscopy and supportive measures, the doctors were able to control the bleeding. Once her general condition had stabilised, patient was started on 3rd line of therapy with a monoclonal antibody which targeted her cancer cells directly, thus sparing her normal cells and improving her chances of tolerating this treatment in spite of the fragile body state. With time, the treatment started to take effect and she was able to walk out of the hospital to which she had come in a stretcher with a life-threatening condition.

The disease again went into remission after 6 months of therapy. However, the prolonged battle with the cancer and advancing age had left her bones severely weakened and she developed a fracture of her right shoulder. Repairing this fracture and replacing the shoulder joint was tricky in the setting of a plethora of previous therapies. Under the expertise of the orthopaedic and joint replacement team, this challenging task was accomplished and the patient was restored to full functional status.

“The patient came to us when she had 3^rd time relapse of cancer called multiple myeloma. She had disease relapse after bone marrow transplantation along with multiple organ failure. This was a very challenging case for us as the patient had multiple organ failure and multi-disciplinary approach was needed to bring her disease back into remission for the 3rd time.  Keeping all this in mind, we used innovative treatment protocol of monoclonal antibody based targeted therapy, post the treatment the patient is doing better, said Dr N. Aditya Murali, Consultant Medical & Haemato – Oncology Bone Marrow Transplant Unit, Aster RV Hospital.

Cancer cells have specific proteins on the cell surface which can be used as a target to identify these unwanted cells and destroy only them and thus sparing normal cells. So monoclonal antibodies have structures similar to these abnormal proteins and thus they are able to identify these cells and damage them selectively.  These therapies are more effective and better tolerated than conventional chemotherapy.

All through this, the patient’s primary caregiver, her husband who himself was over 70 years of age ably supported her, accompanied her to every treatment session, spent many nights in the hospital during the intensive care and continues to walk side by side with her through every step of this arduous journey.

The management of cancer has evolved through the decades with the focus now on understanding the molecular basis of the disease, adapting therapy to target only the disease and reduce side effects, boosting the natural immune system to fight the disease and at the same time involve the various sub-specialities to treat the relevant organ system ailments and ensure that team work will help in increasing the longevity and at the same time maintain quality of life. Faced with cancer, we can either let the disease define our lives or with a personalized and holistic approach, let life triumph over adversity.