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Advanced Therapy Halts Multiple Myeloma, Achieves Lengthy Remission

Gail Jarrett-Black and Todd M. Zimmerman, MD After being treated for multiple myeloma with radiation, chemotherapy and a stem cell transplant, Gail Jarrett-Black, left, participated in a clinical trial of a medication to improve long-term survival. Oncologist Todd Zimmerman, MD, right, says the drug has been very effective in suppressing myeloma cells.

Gail Jarrett-Black was feeling exhausted at the end of her workdays as a third grade teacher. She remembers her husband, Anthony, commenting, "Gail, you need a nap every day."

The 54-year-old Chicagoan had never had health problems and didn’t worry much about her fatigue. However, lab tests performed during a regular checkup in the summer of 2007 revealed her blood had high levels of a protein associated with multiple myeloma.

Multiple myeloma is a cancer that begins in the plasma cells, which are white blood cells in the bone marrow that produce antibodies for fighting infection. When the plasma cells multiply too quickly, they can form tumors near solid bones. These tumors can weaken the bones and make it difficult for the bone marrow to make healthy blood cells. Some patients don't have any symptoms; others may experience bone pain, broken bones, fever, bruising, bleeding, weakness or fatigue.

Jarrett-Black's internist referred her to hematologist/oncologist Todd Zimmerman, MD, an expert in the disease and a member of the nationally recognized multiple myeloma team at the University of Chicago Medicine.

"From the time I walked in until I left the hospital, everyone was fantastic," Jarrett-Black said.

As part of her initial workup, Zimmerman ordered a skeletal survey -- a set of X-rays of all the bones in the body -- to check for tumor lesions near any bone. "The survey showed no evidence of bone damage and Gail exhibited no other symptoms of the disease," Zimmerman said. Because this type of low-grade, slow-growing myeloma doesn’t always develop further, Zimmerman recommended monitoring Jarrett-Black rather than beginning treatment right away.

Several months later, Jarrett-Black had pain in her shoulder but didn't relate it to the cancer. Otherwise, she says she remembers feeling wonderful. Then, in March 2008, Jarrett-Black had sudden debilitating pain in her back. She described it as feeling like "a bolt of lightening going down my spine." An MRI scan showed tumor growth and evidence of new bone damage. The cancer was progressing.

Zimmerman designed a nine-month care plan that included radiation (to reduce the pain), chemotherapy (to bring the cancer into remission) and an autologous stem cell transplant (to return healthy blood cells back to her bone marrow).

While undergoing chemotherapy, Jarrett-Black suffered a personal setback when her 48-year-old husband died suddenly of a heart attack in August 2008. "It was so hard on our teenage son Nicholas," she said. "He thought I was also going to die, too. At that point, I didn’t know myself if I was going to survive." A cousin and several long-time girlfriends cared for her through the remaining chemotherapy, the transplant and the recovery. "I was never alone," she recalled. "They stayed with me 24 hours a day."

A'Jani Baker, Gail Jarrett-Black, Cherie E. Harris Jarrett-Black gives high marks to the University of Chicago Medicine staff -- from the valets to the clinic coordinators to the nurses. Here, Jarrett-Black, center, is pictured with hematology/oncology clinic coordinators A'Jani Baker, left, and Cherie E. Harris, right.

After her stem cell transplant, Dr. Zimmerman asked Jarrett-Black if she would be interested in participating in an ongoing clinical trial of a "maintenance therapy" for multiple myeloma. At the time, the University of Chicago Medicine was taking part in a multi-center national study of an investigational medication to improve survival after stem cell transplantation. Not knowing if she would be given the chemotherapy drug lenalidomide or the placebo, Jarrett-Black decided to enroll in the study.

Six months into her trial period, Zimmerman informed Jarrett-Black that an interim analysis of study results showed the medication significantly improved survival among patients. He also told her that she had been in the group randomly chosen to take the drug.

"We believe lenalidomide acts by suppressing myeloma cells which then halts the progression of the disease," explained Zimmerman. "We don't think of multiple myeloma as curable, but new therapies like this one are very promising for controlling the disease." In the case of lenalidomide, use of the medication to maintain remission is now the standard of care for patients with multiple myeloma.

Approaching the fifth year of her cancer's remission, Jarrett-Black continues to take lenalidomide once a day. She says she hasn't had any setbacks and is at her strongest ever. When she isn't working as a substitute teacher for Chicago public schools, she spends time visiting Chicago’s libraries, parks, concerts and lakefront.

Jarrett-Black sees Zimmerman every few months to have her blood checked for signs of relapse. During her visits, she often tells him, "I am so glad you decided to be a doctor."

She also gives high marks to the University of Chicago Medicine staff -- from the valets to the clinic coordinators to the nurses in the clinics and in the hospital. "From the time I walked in until I left the hospital, everyone was fantastic," she said. "They made every accommodation for me and were always encouraging."

She added, "I can’t say enough about the compassion that was shown to me and how it made me feel. When you are really sick, everything counts."

August 2012