Like many New Yorkers, might-be feminists, hematologists and others, I was saddened to learn of Geraldine Ferraro's death. The Depression-era born mother, public school teacher, attorney, criminal prosecutor, Congresswoman, 1984 Democratic VP-candidate and otherwise accomplished woman from this region, succumbed to complications of multiple myeloma at the age of 75.
Myeloma is a cancer of plasma cells -- specialized white blood cells (mature B lymphocytes) that make antibodies. Plasma cells normally develop in the bone marrow; they can exit into the bloodstream, which is why this condition is often called a tumor of the bone marrow or, occasionally, sometimes, as a leukemia. According to the NCI, over 20,000 North Americans receive a myeloma diagnosis, and approximately 10,000 die from the disorder each year. It tends to arise in older folks, and is slightly more prevalent in men than in women.
What's notable to me, as a hematologist-oncologist -- a doctor trained in malignant blood diseases -- is that the former Congresswoman survived for more than 12 years with a condition for which there were few treatments available when she was on the Presidential ticket. This was partly due to luck -- always a factor in cancer outcomes, as some cases are intrinsically more aggressive than others; partly due to her access to excellent doctors and good care; and, also, likely due to advances in myeloma treatment over the past two decades.
Some perspective: When I completed my fellowship in 1993, the median survival for someone with myeloma was less than three years. Starting around then, most specialists steered patients under the age of 65, and in some communities, older patients as well, toward autologous stem cell transplantation -- an aggressive approach that's been shown to prolong lives of patients in randomized studies. (For the record, I've never been convinced by those data.) More recently, old drugs like thalidomide and its modern derivative, lenalidomide (Revlimid), along with new drugs like bortezomib (Velcade) have demonstrated efficacy in this disease.
In my opinion, what's ahead for doctors caring for myeloma patients -- and for the patients, even more so -- in this decade, is to see if these old and new pills might be better, less costly and less toxic than transplant-based treatment regimens.
In the past 15 years, most hematologists reserved non-transplant care for myeloma patients who were elderly or otherwise debilitated. Now, a few are questioning whether the new meds might obviate the benefit of transplantation for most myeloma patients. This -- a potential shift to new meds including pills for younger patients, even in clinical trials -- may be a hard sell for some medical providers; it's not just some bone marrow transplanters (physicians) who've invested careers in high-dose therapy and grafting protocols, but institutions (i.e. hospitals) that have built expensive, high-tech and profitable bone marrow units. There's a lot at stake in this: egos, money and patients' lives.
A final thought on Ferraro's care -- it seems she benefited from the care of expert specialists and subspecialists. With all the push now for more primary care doctors -- who are indeed needed -- her survival with what might have been a quickly terminal illness is a testament to the value of knowledgeable, well-trained physicians who keep up with developments in an evolving field.
As for the ceiling-breaking congresswoman, my thoughts are with her family now. She was a remarkable lady in many ways.