Cleveland Clinic Abu Dhabi treats complex multiple myeloma, rare POEMS cases

Cleveland Clinic Abu Dhabi has highlighted the importance of a personalised approach to complex plasma cell disorders through the treatment of two patients with markedly different journeys. The first patient was living with high-risk multiple myeloma that continued to progress despite several advanced treatments, while the second was diagnosed with POEMS syndrome, a rare plasma cell disorder. The management of both cases demonstrates the importance of precise diagnosis, individualised treatment planning, and specialist experience.

The first patient, a 53-year-old woman, was diagnosed with multiple myeloma after developing tailbone pain in 2018. Over the following years, she underwent multiple lines of treatment, including an autologous stem cell transplant, antibody-drug conjugate therapy, bispecific antibodies, chemotherapy, and radiation therapy. Despite these interventions, her high-risk myeloma continued to progress. She had a high disease burden involving both her bone marrow and areas outside it. She was experiencing fatigue and discomfort, while low blood cell counts made further treatment more complex because of the potential impact on her bone marrow.

After reviewing her treatment history and disease profile, the team identified established medicines she had not previously received, with her response monitored through myeloma blood tests, PET imaging, and bone marrow biopsies. Following treatment, masses associated with her myeloma decreased in size, and her clinical results improved.

The second patient, a 42-year-old man, was diagnosed with POEMS syndrome after his symptoms, which started with stiffness and numbness in his feet, were initially attributed to a neurological condition. Further assessment revealed POEMS syndrome, a rare plasma cell disorder that can affect multiple systems in the body and is characterised by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes.

Dr. Ajlan Al Zaki, Staff Physician, Hematology & Blood Cancer, Cancer Institute at Cleveland Clinic Abu Dhabi, said, "Plasma cell disorders can behave very differently from one patient to another, which means there is no single approach that works for everyone. We have to understand the biology of the disease, look closely at the patient's complete clinical picture, and determine the most appropriate strategy for that individual."

He explained, "Treatment planning in multiple myeloma can be like a game of chess. You need to decide on the best move for the patient now while thinking several moves ahead. Newer therapies are not always the right answer at every stage. Sometimes an established treatment, used at the right time and in the right sequence, can provide effective disease control and help create opportunities for future treatment."

Dr. Al Zaki added that diagnosing rare conditions such as POEMS syndrome requires connecting symptoms and clinical clues that may appear unrelated and considering uncommon diagnoses. He stressed the importance of early diagnosis in determining the appropriate treatment.

WAM