Defining Multiple Myeloma
In 1844, the same year of Sarah Newbury’s death, another resident of London, Thomas Alexander McBean, experienced an agonizing pain “as if something had snapped or given way within the chest” followed by an “intense agony” leaving him prostrate. When doctors applied a plaster to relieve his pain, it seemed to help until he exhibited a general swelling of his body in 1845.
McBean’s physicians performed experiments on his urine, which reacted in ways they had never seen. They sent the sample to Henry Bence Jones, a young physician who had a talent for what would later become known as biochemistry.
It had been just ten years earlier that proteins in plasma were identified and named, the most prevalent being albumin. When examining McBean’s urine sample, Bence Jones recognized a protein that had never been observed before and connected it to “mollities ossium,” a softening of the bones. McBean’s physicians responded with more plasters, blood removal, quinine, and applied what was state-of-the-art medicine at the time: leeches. Despite some immediate relief, McBean died on January 1, 1846.
Although the precise cause of his death was not known, the Bence Jones protein, as it would become to be called, was inextricably linked to the bone degeneration both Newbury and McBean experienced. More answers would take a few more decades to be found, but European medical journals would occasionally report on case studies of patients exhibiting similar features, all leading to quick death. McBean’s months of survival would prove to be much closer to the norm than Sarah Newbury’s four years.
By May 1872, in Kiev, Ukraine, a Dr. J. v. Rustizky came upon a case study of a physician in Strassburg, a city in present-day south-central Austria, about a forty-seven-year-old peasant who sought a doctor’s advice about a bean-sized lump on the right side of his skull’s temple. It didn’t cause any discomfort other than itching and had a soft clay-like consistency that bounced back to its shape when pressed.
Within months it grew to the size of an apple. By June he felt a weakening of his left leg which then spread to his right, causing walking difficulties. As the pressure on his eye soon caused an inability to tolerate light, tumors were spreading, making him bedridden, causing lung infections, diarrhea, incontinence, and a rising pulse. He died on December 18, 1872.
His autopsy revealed eight tumors in different parts of the skeleton and an inner consistency of gelatinous substance that had replaced the expected spongy bone marrow as well as brittle bone encasing it. Rustizky’s first thought was that it was another case of bone cancer recently been cited in a case studay by Rudolf Virchow, the father of pathology, in Berlin, Germany.
But upon closer study of the records, he realized the bone destruction was a symptom; the cause was in the marrow. And the tumors spread out throughout the skeleton were all of the same type, practically identical when seen through a microscope.
Using the Greek terminology for medicine, he posited that the tumor, the “oma,” was in the “myel,” the marrow. And it was in multiple places. The mysterious disease now had a name – which was the title of Rustizky’s scientific paper written in German – multiples myelom.
It wasn’t until 1889 when Otto Kahler, a forty-year-old professor of medical pathology at the German University in Prague, presented the first paper on the symptomology of multiple myeloma to a meeting of German doctors in Prague. It brought together and explained the known literature, but it was ignorant of the work of Bence Jones. Kahler’s life would sadly change the next year, after he had accepted a position at the University of Vienna, when he had a small tumor removed from his tongue; one that would take his life in 1894.
Despite his short association with myeloma, the condition he described soon became widely known as Kahler’s Disease, a term still used in many parts of Europe and other parts of the world well into the 1960s. Not that much had changed for patients in that time. Which helped explained why myeloma didn’t have much going for it for the average medical student graduate for the next 150 years.
Unlike more common cancers such as breast or prostate, there weren’t enough myeloma patients to build a practice around, especially since they were not likely to be long-term customers. Little-to-nothing could be done to treat myeloma, whose patients made up slightly more than one percent of all the people diagnosed with a cancer annually and represent slightly about two percent of those who die. The best a doctor could do was to alleviate painful symptoms and side effects that led to inevitable decline along the way to an anticipated death, generally within months.
More than a century and a half after Sarah Newbury’s death, basic research in myeloma existed, but it rarely translated into longer lifespans and certainly not into cures. There were other more interesting and more lucrative things to study. They wanted to treat people to make them better; myeloma only offered expected decline before inevitable death.
There wasn’t much going on besides, possibly, perhaps, there was a relatively new treatment called stem cell transplant. Even that didn’t significantly add to survival statistics. Very few became interested in this hopeless, bleak type of cancer. Even fewer than those who were begrudgingly assigned to study or treat it.
By the mid-1950s, one young doctor at the Mayo Clinic in Rochester, Minnesota would begin to view the mystery of myeloma and hematology far differently than his peers. Unsolved questions were a challenge to him, not a frustration. Plus, Mayo gave him training, freedom, resources, and access to patients. It also balanced institutional pressure with support and time to collect and share his findings in professional journals. He hadn’t yet realized he found a scientific riddle to keep him fulfilled for years.
Over his career, Robert Kyle would build the foundation needed to launch a revolution no one could envision.
And that had a lot to do with where he came from, which will be the subject of the next Substack article.
Photo: Detail, Adrien Dauzats The Great Pyramid, Giza (1830 or later), The Metropolitan Museum of Art, New York