Multiple Myeloma Treatment in Shanghai: A Guide for International Patients
Multiple myeloma is a cancer of plasma cells — the antibody-producing cells of the immune system — that accumulate in the bone marrow, crowding out normal blood cells and producing abnormal proteins (M-proteins) that can damage organs including the kidneys, bones, and nervous system. It is the second most common blood cancer globally, accounting for approximately 10% of all hematologic malignancies.
While multiple myeloma remains incurable with standard therapy, it has been transformed from a rapidly fatal disease into a chronic condition that many patients manage for a decade or more. The past two decades have seen a succession of highly active novel agents — proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and most recently BCMA-targeted CAR-T cell therapies — that have dramatically improved outcomes. For international patients, Shanghai offers access to this full spectrum of modern myeloma therapy, combined with the expertise of some of China's most accomplished myeloma specialists.
Why Shanghai for Multiple Myeloma?
Shanghai has several specific advantages for international myeloma patients:
CAR-T Therapy Access: China has been a global leader in the development and clinical application of BCMA-targeted CAR-T therapy for myeloma. Multiple BCMA CAR-T products have been approved in China, and Shanghai's leading hematology centers have accumulated substantial clinical experience with this modality. For patients in countries where CAR-T therapy is unavailable, prohibitively expensive, or subject to long waiting lists, Shanghai offers a meaningful alternative.
Novel Agent Availability: Shanghai's leading centers have access to the full range of approved myeloma agents, including daratumumab, isatuximab, carfilzomib, pomalidomide, ixazomib, selinexor, and belantamab mafodotin. Access to these agents in many countries outside the US and Europe remains limited.
Clinical Trial Access: Shanghai is one of China's most active centers for myeloma clinical research, with ongoing trials in next-generation CAR-T constructs, bispecific antibodies, novel targeted agents, and combination strategies.
International-Level Expertise: Shanghai's myeloma specialists include IMWG committee members, national guideline authors, and physicians with international training — ensuring that treatment decisions are informed by global best practice.
Understanding Multiple Myeloma: Key Concepts
CRAB Criteria: The classic features of myeloma requiring treatment are summarized as CRAB: hyperCalcemia, Renal impairment, Anemia, and Bone lesions. Not all patients present with all features, and some patients have smoldering myeloma (asymptomatic) that requires monitoring but not immediate treatment.
Cytogenetic Risk Stratification: FISH testing of bone marrow plasma cells identifies chromosomal abnormalities that define risk categories. High-risk features include del(17p), t(4;14), t(14;16), and gain(1q). High-risk patients require more aggressive induction and maintenance strategies and have a different prognosis than standard-risk patients. Cytogenetic testing is essential at diagnosis and should be repeated at relapse.
M-Protein Monitoring: Serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), and serum free light chain (SFLC) assays are used to quantify M-protein and monitor treatment response. Response categories (sCR, CR, VGPR, PR) are defined by the IMWG and guide treatment decisions.
MRD (Minimal Residual Disease) Testing: Next-generation sequencing (NGS) or flow cytometry-based MRD testing can detect residual myeloma cells at levels below standard response criteria. MRD negativity is increasingly recognized as a surrogate for improved long-term outcomes and is used to guide maintenance therapy decisions at leading centers.
Treatment Overview: Newly Diagnosed Myeloma
Transplant-eligible patients: Standard induction with a triplet or quadruplet regimen (VRd: bortezomib + lenalidomide + dexamethasone, or Dara-VRd: daratumumab + bortezomib + lenalidomide + dexamethasone), followed by autologous stem cell transplantation (ASCT) and lenalidomide maintenance. The addition of daratumumab to induction and maintenance (GRIFFIN, PERSEUS trials) has further improved outcomes.
Transplant-ineligible patients: Daratumumab + bortezomib + melphalan + prednisone (Dara-VMP) or daratumumab + lenalidomide + dexamethasone (Dara-Rd) as continuous therapy. Bortezomib + lenalidomide + dexamethasone (VRd) remains an option for patients who cannot access daratumumab.
Treatment Overview: Relapsed/Refractory Myeloma
The treatment of relapsed myeloma has become increasingly complex, with multiple active drug classes and a growing number of approved agents. Key principles include:
- Selecting agents from drug classes not previously used or to which the patient is not refractory
- Considering prior toxicities (peripheral neuropathy from bortezomib/thalidomide, renal function for melphalan dosing)
- Evaluating eligibility for BCMA-targeted therapies (CAR-T, bispecific antibodies, ADCs) in later lines
- Assessing clinical trial eligibility at every relapse
Second-line options: Carfilzomib-based triplets (KRd, KPd), pomalidomide-based regimens, isatuximab combinations, elotuzumab combinations.
BCMA-targeted therapies for triple-class refractory disease: Patients refractory to a proteasome inhibitor, an IMiD, and an anti-CD38 antibody are candidates for BCMA CAR-T therapy (ciltacabtagene autoleucel, idecabtagene vicleucel), BCMA bispecific antibodies (teclistamab, elranatamab), or belantamab mafodotin (BCMA ADC).
Metronomic chemotherapy: For patients who have exhausted novel agent options or who cannot tolerate standard regimens, metronomic (low-dose continuous) chemotherapy approaches — including the regimen developed by Dr. Zhou Fan that has been incorporated into China's national myeloma guidelines — offer an alternative with a favorable tolerability profile and survival outcomes that exceed international benchmarks in selected patients.
Shanghai's Leading Myeloma Specialists
CMCS works with a network of Shanghai's most accomplished myeloma specialists, each bringing distinct expertise:
Prof. Hou Jian (侯健) — Renji Hospital, Shanghai Jiao Tong University
Widely regarded as China's foremost myeloma authority and known as "China's Myeloma Man." IMWG committee member and principal author of national myeloma guidelines. Renji Hospital has an active CAR-T program for relapsed/refractory myeloma. Ideal for: newly diagnosed high-risk myeloma, complex relapsed/refractory cases, CAR-T eligibility evaluation, clinical trial access.
Prof. Liu Peng (刘潁) — Zhongshan Hospital, Fudan University
Leads the No. 1 ranked hematology department among Shanghai municipal hospitals. CSCO Myeloma Committee Vice-Chair with expertise in both myeloma and lymphoma. Zhongshan's comprehensive subspecialty ecosystem is particularly valuable for patients with myeloma-related complications. Ideal for: complex myeloma with organ involvement, patients needing multidisciplinary support, lymphoma co-management.
Prof. Shi Jumei (施菊妹) — Oriental Hospital Shanghai
30+ years of myeloma experience including clinical training at UAMS — one of the world's premier myeloma centers. Expertise in novel agents, ASCT, and CAR-T therapy. Ideal for: patients who have been treated at international centers and want a Chinese specialist with international training, ASCT candidates, CAR-T evaluation.
Prof. Du Juan (杜鹃) — Changzheng Hospital, Naval Medical University
A decade of focused expertise in myeloma targeted therapy and molecular mechanisms, with internationally recognized CAR-T expertise. Ideal for: triple-class refractory patients seeking CAR-T, patients with drug-resistant disease where molecular profiling may identify rational next-line options, clinical trial access.
Dr. Zhou Fan (周帆) — Shanghai Jing'an District Zhabei Central Hospital
Developer of the metronomic chemotherapy regimen incorporated into China's national myeloma guidelines, with patient survival exceeding international benchmarks. 2024 Shanghai Good Doctor nominee. Ideal for: relapsed/refractory patients who have exhausted novel agent options or cannot tolerate standard regimens, patients seeking a tolerable long-term management approach.
How to Choose: Matching Patient Needs to Specialists
For CAR-T therapy evaluation: Renji Hospital (Prof. Hou Jian), Oriental Hospital (Prof. Shi Jumei), or Changzheng Hospital (Prof. Du Juan) are the primary options, all with active CAR-T programs.
For complex or high-risk newly diagnosed myeloma: Any of the major academic center specialists (Prof. Hou, Prof. Liu, Prof. Shi, Prof. Du) are appropriate. CMCS will help match based on specific disease features and patient preferences.
For myeloma with significant organ complications (renal failure, cardiac amyloidosis, severe bone disease): Zhongshan Hospital (Prof. Liu Peng) offers the broadest multidisciplinary support within a single institution.
For relapsed/refractory patients who have exhausted standard options: Dr. Zhou Fan's metronomic approach offers a distinct alternative worth evaluating alongside CAR-T eligibility assessment.
Important note: Specialist clinic schedules and availability may change. CMCS confirms current availability and appointment logistics before any travel is arranged.
What to Prepare Before Your Shanghai Consultation
- Bone marrow biopsy report with plasma cell percentage and histology
- FISH cytogenetics panel (del17p, t(4;14), t(14;16), gain 1q at minimum)
- M-protein quantification: SPEP, UPEP, serum free light chains (most recent and serial values)
- Imaging: whole-body low-dose CT or PET-CT for bone lesion assessment
- Organ function: renal function (creatinine, eGFR), calcium, LDH, beta-2 microglobulin, albumin
- Complete prior treatment summary: all agents received, cycles, responses, and reasons for discontinuation
- MRD testing results if available
- Cardiac assessment if AL amyloidosis is suspected (echocardiogram, troponin, BNP)
How CMCS Coordinates Myeloma Care in Shanghai
China Medical Concierge Shanghai (CMCS) is a health management company — not a hospital — that specializes in connecting international patients with Shanghai's leading specialists. For myeloma patients, our coordination includes:
- Case triage to the most appropriate specialist based on disease stage, molecular profile, prior treatment history, and specific needs (CAR-T, transplant, second opinion, etc.)
- Medical record translation (English, Arabic, French, Russian, and other languages)
- Remote pre-consultation case review before travel commitment
- Appointment scheduling across hematology, transplant, and CAR-T programs
- On-site interpretation during all consultations and procedures
- Clinical trial eligibility assessment and enrollment support
- Post-consultation summary and ongoing follow-up coordination
- Liaison with the patient's home hematologist for continuity of care
Contact CMCS to Begin Your Myeloma Consultation
📧 contract@medicalsh.com
💬 WhatsApp: https://wa.me/message/3AM6KAGCW2BAD1
🌐 www.medicalsh.com
CMCS – China Medical Concierge Shanghai connects international patients with Shanghai's leading specialists. We are a health management company, not a hospital. All clinical decisions are made by the treating physician. This guide is for informational purposes only and does not constitute medical advice.
0 Kommentare