by Vera Martinella
The musician returns to public after a long break for treatment. Symptoms, standard and new treatments that prolong the survival of those who get sick. Very frequent relapses, but today one can aspire to recovery
He made the announcement himself in June 2022 in a post on Instagram: I won’t beat around the bush: I discovered that I have a sweet-sounding neoplasm: myeloma, but no less insidious. Since then the musician Giovanni Allevi, 54, has repeatedly updated fans via social media on his health conditions, describing in words and photographs a painful and difficult journey. This evening, on the stage of the Sanremo Festival, the pianist and composer returns to public for the first time after a long break which was necessary for treatment. The disease was discovered following tests carried out due to excruciating back pain that tormented him: Often, in the initial stages, multiple myeloma shows no signs or presents itself with non-specific symptoms such as tiredness and back pain, says Paolo Corradini, president of the Italian Society of Hematology and director of the Hematology Division of the IRCCS Foundation National Cancer Institute of Milan.
Symptoms
What does bone pain have to do with it? Myeloma is a tumor that affects some cells contained in the bone marrow which have the function of producing the antibodies necessary to fight infections: plasma cells – replies Corradini -. The abnormal growth of tumor plasma cells can cause a reduction in the normal production of hematopoietic cells (red blood cells, white blood cells and platelets) causing anemia (with consequent asthenia, i.e. great tiredness), lowering the number of white blood cells (with predisposition to infections) and/or a decrease in platelets (increasing the risk of bleeding) and bone fragility. In fact, most symptomatic myeloma patients suffer from bone pain (mostly in the spine and ribs), which is present in approximately two-thirds of newly diagnosed patients and often leads to bed rest. Bone fractures and spinal cord injuries are also common.
The therapies
For asymptomatic patients (and without other particular conditions) there is no indication for any treatment and frequent checks are carried out to check for any evolution of the tumor. For all the others, who instead require treatments, there are many options available today and the strategy is established based on a series of parameters calibrated to the individual case. Multiple myeloma is a pathology typical of advanced age and treatments must however take into consideration the general situation of the patient – underlines Michele Cavo, director of the Sergnoli Institute of Hematology at the University of Bologna and IRCCS University Hospital of Bologna – : those aged up to 65-70 years and with good organ function (heart, lung, kidney, liver) are generally candidates for a more intensive therapeutic approach, which includes (in addition to biological drugs), transplant of autologous bone marrow (also called autotransplant, because the cells are taken from the patient himself). Those who are not eligible generally receive therapy based on the use of biological drugs associated or not with chemotherapy.
Very frequent relapses
This neoplasm remains, however, very insidious because it involves temporary remissions followed by relapses and almost 9 out of 10 patients experience a relapse over time. When this happens, the therapies involve, if possible, the use of drugs belonging to classes to which the patient has not previously been exposed, with selective use of radiotherapy. Since the beginning of the 2000s, the therapeutic approach has changed radically thanks to the availability of new biological drugs which have demonstrated great effectiveness and have significantly extended the survival of patients.
Hopes for recovery
We went from a few months of life to an average survival of many years – says Cavo -. Now we combine medicines with different mechanisms of action (immunomodulators, proteasome inhibitors, monoclonal antibodies) so as to target the tumor on multiple fronts. We administer them before or after the stem cell transplant (not always foreseen), we have consolidation and maintenance therapies, with the aim of eliminating all cancerous cells (technically it is called “negativeizing minimal residual disease”). And then for the first time in the history of this tumor, we have the hope of being able to recover. We must be cautious, so as not to give false hope to patients, but those who have to face this neoplasm today can do so aware of the fact that scientific research has made much progress and can offer a very effective and relatively broad therapeutic armamentarium.
New therapies on the way
There are also further new therapies against multiple myeloma, some already available in our country, others which should be approved shortly: Bispecific antibodies are currently prescribed to patients who have not received the hoped-for benefits from standard treatments and in whom the disease progresses , progresses after the treatments – concludes Corradini -. We are then waiting for the green light for CAR-T, again for those who are refractory to treatment or have had relapses, which have already given us hope for the recovery of patients with other blood tumors and we expect the same to happen in myeloma.
The cause
The causes of multiple myeloma are not yet known, but the disease predominantly affects people over 65. There are more or less 4,500 new cases diagnosed every year in our country and the majority of patients are over 50 years old (cases before 40 are very rare). Approximately 42% of patients live five years after diagnosis, but survival depends on various factors and thanks to the arrival of new drugs, life expectancy can be many years longer.
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February 7, 2024 (modified February 7, 2024 | 7:37 pm)
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