Multiple Myeloma (MM) is a rare type of blood cancer, with approximately 34,000 new cases diagnosed in the United States each year, and it affects multiple locations in the body including the bone. In total, MM accounts for about 1 to 2% of all cancers diagnosed, and about 10% of all blood cancers. In April of 2022, when a fall landed Bruce Brown, then 59, in his local Emergency Department, cancer was the last thing on his mind. It was determined that he had broken his back and, due to the severity, he was transferred to Yale New Haven Hospital for further work-up.
It was immediately clear that something other than a fall had caused the severe damage to Bruce’s spine. 75 percent had disintegrated, and the remaining 25 percent had been shattered during the fall. Further testing revealed the diagnosis of multiple myeloma, something Bruce and his wife Janet knew very little about.
“Multiple myeloma is rare and is not a cancer that is talked about a lot and we found ourselves doing a lot of research,” recalled Bruce. “Once it was discovered that multiple myeloma was the cause for my weakened spine, I did not think I would ever walk again. The prognosis was bleak.”
However, the initial focus was not on the cancer, but on fixing his spine so that he could undergo treatment. In May of 2022 a spinal fusion surgery was performed, the shattered vertebra was removed, and a spinal cage was built to create a stable fix to the damaged area so that Bruce was able to walk again. Ehud Mendel, MD, MBA, Nixdorff-German Professor of Neurosurgery and Disease Center Director of the Spine Oncology Program at Smilow Cancer Hospital and Yale Cancer Center, performed the surgery and remarked that the case was very complex for a few reasons.
“Mr. Brown’s care required a multidisciplinary approach with arrangements of hematology, neuro-oncology, and pain management all involved. When I first met him, he was newly diagnosed with multiple myeloma and unable to move around independently in his hospital bed. We had to form a level of trust very quickly as his surgery was planned 24 hours after our first meeting,” said Dr. Mendel.
Dr. Mendel brought his entire team to meet Bruce and his family to ensure everyone knew who they were and how they were going to manage his care. Based on his experience, this approach helps patients and the family to understand step by step what to expect and to feel comfortable with the process. Dr. Mendel commented, “That is what we call the Smilow experience. There is nothing in the world like it. My team was always available to answer concerns and questions, including residents, nursing staff, and my leadership team. Sometimes ‘it takes a village’ to take care of our patients. This was one of those times.”
Once Bruce had recovered from the surgery it was time to focus on treating the cancer, first with radiation followed by a targeted combination chemotherapy consisting of a proteasome inhibitor (Velcade), an immunomodulatory agent (Revlimid), and a steroid (dexamethasone) to combat the growth of myeloma. VRd, as it is commonly known, was approved in 2019 and Bruce and Janet were skeptical since it was a newer treatment modality.
“We did our own research and listened to what the doctors had to say and decided to go ahead with the treatment that was administered over a four-month period,” said Bruce. “The network of expertise at Smilow is truly unparalleled. Everyone you talk to is so knowledgeable and you know you are talking to the best of the best. My medical oncologist, Dr. Victor Chang, my hematologist, Dr. Natalia Neparidze, and my radiation oncologist, Dr. Tim Robinson, I cannot say enough about each and every one of them. I was offered the most current and evolving treatments available, all right near home.”
There were some bumps along the way, including after treatment when Bruce developed some pain near the top of his vertebrae and had to undergo an augmentation surgery to correct the issue. But by April 2023 things started to improve and by August he was walking normally again after working with a physical therapist. Now a year and a half out, he looks back on the experience and comments that although it was difficult physically, he felt supported the entire time. His advice to others is to ask questions and to listen and engage with the experts.
“We met a lot of amazing people that supported us along the way,” said Bruce. “AIienne Sallerolli (Assistant Patient Services Manager at Smilow Cancer Hospital), was truly remarkable. There was a point while in the hospital that I was feeling really low, and she took the time to walk me to the healing garden on the seventh floor and just talk and sit with me. It was a huge part of my recovery, and she did not have to do that. I am not sure where you get people like that, but I am so grateful. She even put my name on her jersey when she rode in the Smilow Closer to Free bike ride. It meant a lot to me and my family.”
Overall the physical journey was a difficult one and Bruce’s situation was anything but typical. He commented that Dr. Mendel’s description of his case being like a zebra has stuck with him. In the same way that the developmental processes that creates stripes in zebras is complex and difficult to untangle, so to was Mr. Brown’s case that involved several layered complexities. However, he has almost fully recovered and is once again playing with his granddaughters and enjoying life. According to Bruce his recovery is a miracle, a miracle performed under the guidance of some of the best experts in the world.
Dr. Mendel remarked, “After two very complex surgeries, to watch Bruce walk unassisted into my clinic is why I do what I do. It's not just the surgery, it’s caring for the person, their individual needs and the experience they and their family have. It is all those things and more.”