Keith was one of the first patients in Australia to try Daratumumab.

Daratumumab provides hope to those with Multiple Myeloma

by Mackenzie Gignac

Multiple Myeloma (MM) is a blood disease that affects around 18,000-20,000 Australians each year. Initially, the diagnosis might be ill-received when patients hear that this disease is incurable. However, there has been a lot of advancements in treating this particular condition. New clinical trials that focus on treating MM have extended the life expectancy and quality in those diagnosed.

In November of 2018, Keith Halge received news that MM was found in his body, the same disease that affected his mother as well. Because of this, he had a decent amount of knowledge about the condition with one alarming aspect, ‘I knew it was not a cancer that would not go away,’ says Keith.

Keith’s mother was 75 years old when she received her diagnosis. He said from his perspective he saw some of the serious effects the condition had on her, so the news left him feeling devastated.

Luckily for Keith, Associate Professor Hang Quach and her team at St. Vincent’s were looking to bring a new treatment for MM to Australia. Currently, the combination of Bortezomib, Lenalidomide, and Dexamethasone are being used in the United States and Europe to treat people with Myeloma, but this combination has only received PBS reimbursement in Australia as of 1 June.

A powerful immune drug called Daratumumab is being added to this combination in credit to a clinical trial conducted by A/Prof Quach and her team at St. Vincent’s. This so-called ‘quadruplet’ combination is anticipated to be the way of the future because of its expectation to induce a deeper and more durable response than the current standard of care treatment.

‘I took the advice that this would be the best shot for me. There was obviously evidence in Europe that it had worked successively. ’ says Keith. He also says that A/Prof Quach’s knowledge, expertise and positivity gave him the confidence to give this treatment option a shot.

‘After speaking with Hang this wasn’t a ‘should I do this?’ it was a ‘yes, sign me up as quickly as you can.’’

Keith was the first person to undergo this clinical trial in Australia. His treatment included STEM cell transplant as well as Daratumumab Bortezomib and Lenalidomide.

Keith began his treatment of MM starting with a month of STEM cell transplant in February 2019. Now he receives maintenance treatment to keep cancer at bay and is taken through the use of daily oral drugs on top of a monthly intravenous injection that is administered at the hospital.

He credits the monthly hospital frequency as one of the sources of his courage to try the clinical trials. ‘It’s not like I’m waiting every one, two, or three years and hoping in the meantime everything is ok,’ says Keith. ‘They will know very quickly if there is a change to my condition and if they will need to change things.’

The drugs are working to battle the cancer but, unfortunately, this comes with additional physical impacts on the body. ‘My feet are somewhat numb and tingly all the time, so that’s uncomfortable,’ says Keith. Additionally, eating food might be a struggle at times dealing as the drugs affect food taste as well as the symptom of persistent nausea.

However, one of the most confronting symptoms Keith mentions is the hair loss due to the stem cell transplant. ‘Having to walk around in a beanie made me feel like more of a cancer patient,’ says Keith. ‘It creates the knowledge in your mind that you are a cancer patient.’

The good news is that after stem cell transplant, hair will start to return 6-12 months after the treatment ends. ‘My hair did come back after 6 months, and you know what I probably have a thicker head of hair now,’ says Keith.

However, there was more than just physical effects that Keith endured. ‘STEM cell transplant was one of the most difficult things I dealt with throughout the whole process,’ recalls Keith. The hospital isolation paired with nausea took a psychological toll on Keith. ‘It was tough, you need to tell yourself it’s only one month,’ says Keith.

Keith’s road to remission wasn’t achieved without complications. Before starting treatment, doctors found a myeloma tumour (plasmacytoma) in a sensitive area at the top of his spine. Keith had to undergo radiotherapy and surgery simultaneously.

Doctors went in for surgery to stabilise Keith’s neck with two rods and a titanium plate at the base of his scalp. These additions do not make life any easier for Keith. ‘It has severely restricted my level of movement in my neck to turn to either side,’ says Keith. ‘If I’m not feeling nauseous from medication then my neck is extremely stiff.’

However, Keith comments that although there are side effects they are manageable. ‘With this disease, there are incredible advancements and even with rods in my neck and medication, I am back at work,’ says Keith.

For any future MM patients, Keith offers a couple of words of advice to avoid Google. ‘You get on Google and it takes you to a fairly dark place,’ says Keith. ‘This will not be a disease that kills you in 3-5 years; it’s something that can be managed.’

Additionally, Keith encourages MM patients to wait and see what your medical professional has to say. ‘Trust your doctors, they are the experts and are trying to help you in any way they can,’ says Keith.

A/Prof Hang was one of the greatest comforts Keith had throughout his treatment process. ‘I know that getting ahold of a specialist is difficult to do, but I know that if I send her a message today in half an hour or an hour I would get a response from her,’ says Keith. ‘That is very comforting because you know that you’re not being abandoned, you’re not just a number.’

‘She actually goes above and beyond to make her patients feel comfortable and supported. There’s not a lot of specialists who do that, so I am lucky to have her on my team.’

Lastly, Keith also mentions that it is important that MM patients stay positive, ‘if you constantly think about your morbidity it becomes a bit of a cycle.’ He suggests trying to live as normal of a life as possible. ‘For me, it has been helpful in going back to work. The whole point of it [the treatment] is to live your life as normal as you can. So, you might as well do it,’ he says.

Normal life for Keith even includes doing some world travel. Keith had a trip to visit Europe for a month, which ultimately had to be canceled due to COVID-19. ‘The doctor had no problem with me going and enjoying that part of my life,’ says Keith.

‘They want you to live your life and be happy. They are doing a lot of the work to allow you to continue to be happy.’

There is hope for people who have been diagnosed with MM. While it is technically not a blood disease that can be cured new therapy options are able to help manage it, allowing patients to live a longer and healthier life than before.

For anyone looking to treat their MM diagnosis, our team of doctors at Melbourne Blood Specialists can access you for your specialised appropriate treatment plan.