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Multiple Myeloma: A Milestone of One Hundred Treatments on a Clinical Trial

Robert and Audrey Krahn with Dr. Natalie Callander

In 2004, malignant plasma cells took root in Robert Krahn's bone marrow and began breaking down his bones. He became very ill and anemic while antibodies produced by these cells clogged his kidneys, causing them to fail. When his doctors discovered it was multiple myeloma, a cancer that stems from abnormal antibody producing cells invading the bone marrow,, the prognosis wasn't good.

 

When Robert was diagnosed with myeloma in 2005, there were few options for sustained care. At the age of 74, he wasn't a candidate for strong chemotherapy or a bone marrow transplant. Steroids that slow down the hijacked immune system of myeloma patients would sustain Robert's life by a few months, maybe a few years at best.

 

With his options limited, Robert, his wife Audrey, his daughter Robin and her husband Steve Fiorentino began a nationwide search for an alternative at a time when there were only experimental drugs in the pipeline. Fiorentino, himself a pharmacist, had investigated cancer centers around the country for a myeloma specialist until he was recommended to Natalie Callander, MD.

 

Previously a faculty member at the University of Texas Health Science Center in San Antonio, Dr. Callander had just accepted a position at the UW Carbone Cancer Center to promote myeloma research and treatment here in Madison. As Associate Professor at the UW Madison School of Medicine and Public Health, the hematology and bone marrow transplant specialist began asking patients to consider enrolling in a clinical trial offering a promising new myeloma drug called lenalidomide, marketed currently under the name Revlimid. Robert agreed to participate, and became one of the first patients in Madison to enroll in the trial.

 

Robert's daughter Robin says the cautious optimism that Callander brought to the table was comforting. "I was so grateful that he was given the chance to take part in the study. She always looked towards the longer-term of treating him. By being so patient in helping us understand the process, it made me feel like he wasn't just a number."

 

Eight years later, a week before his 82nd birthday, Robert began his hundredth cycle of Revlimid on September 5, 2013. Joking about his golf swing, Robert doesn't complain much about his condition. While he's not cured, Robert's kidneys have healed and his life is no longer in danger from the disease. In the intervening years, Revlimid has become part of the standard of care for myeloma, and Robert's case played a huge role in proving its usefulness. As one of the first to enroll in a trial for the drug, Robert helped prove that the agent could work well for a long period of time.

 

Moreover, his participation underscores that older patients can also benefit greatly from participation in clinical trials and should be actively recruited. "Cases like Robert's have shown us that Revlimid is safe, effective and can be used with lower doses of steroids which might otherwise compromise the immune system," says Callander. "Now, most patients being treated for myeloma will receive Revlimid at some time in their disease course."

 

Callander also uses another word rarely used in the cancer world that she hopes will describe the disease in the future: chronic. "Robert's cancer isn't gone," she says, "but if we looked for myeloma cells in his bone marrow, we'd probably have a hard time finding them." "I'm still active." Robert says of his day to day life. "I bowl and golf, although not as well as I once did. I also attend many of my granddaughter Stephanie's activities."

 

Meanwhile, Callander and her UW Carbone Cancer Center colleagues are studying the conditions that allow myeloma cells to grow in the first place, brightening the future for people stricken by myeloma even further. "In the last 20 years, we've seen a remarkable movement towards survivorship with myeloma," she says. "We intend to continue this trend."