Melbourne man Ralph Markham looks to emerging treatments to fight aggressive blood cancer

Melbourne man Ralph Markham’s life was changed by love and then a devastating cancer diagnosis. He now hopes new treatments will give him more time with his wife, Cathy, and their blended family.

Mr. Markham, 65, first met Cathy when she was a teenager in Canada. Twenty years later, after both had ended their first marriages, Mr. Markham reached out to Cathy via Facebook.

Their rekindled friendship blossomed into love and the couple now share a life in Cranbourne South, Victoria.

“We used to be friends, part of the same group of friends,” Mr. Markham said.

“The boys lived on the west side of the street and the girls lived on the east side. I was dating one of their friends at the time, so I moved away, but I always remembered Cathy fondly.”

After reconnecting to the internet, Ralph and Cathy planned a first date in Honolulu, Hawaii, roughly halfway between their homes in Canada and Australia.

This two-week trip set the stage for a long-distance romance that would eventually lead to marriage.

“Three weeks after I went home, I decided I wanted to see more of Cathy, so I came to Australia for the first of six visits in less than two years. I concluded it would be cheaper to marry her than to continue visiting,” Mr. Markham recalled with a laugh.

But the Markhams’ happiness was interrupted three years ago when Ralph began experiencing unexplained illnesses, including shingles and recurring infections.

“I went to donate blood, but the Red Cross rejected me. They said there was something wrong with my blood,” he said.

“I spent the next year having tests with no clear answers. Finally, I was referred to a hematologist, and after four days of a battery of tests he told me, ‘You have cancer.’ It was multiple myeloma, I’d never even heard of it.”

Multiple myeloma is an incurable blood cancer that affects plasma cells in the bone marrow, weakening the immune system and causing bone lesions, anemia and other complications.

It is estimated that approximately 22,000 people in Australia are living with multiple myeloma at any given time; more than 2,600 new diagnoses are made each year; This number is expected to almost double by 2043.

The five-year survival rate for Australians with myeloma is just 60.7 per cent; this rate is significantly lower than for breast, prostate or colorectal cancers.

Mr Markham’s initial treatment included a line of VRD therapy followed by a stem cell transplant, which he said “pretty much didn’t work”.

Over time, maintenance treatment also ceased to be effective, leaving the family facing an uncertain future.

To make matters even more difficult, a friend of theirs in Canada was also diagnosed with myeloma and died less than a year later.

“It was always in the back of my mind,” Mr. Markham said.

The emotional toll for Ms. Markham has been just as heavy.

“It’s a weird place to be because you’re always anticipating grief. Time is of the essence. We don’t want to waste the time we have right now,” he said.

“We have good days and bad days. We try to enjoy every moment because you never know how many more moments are left.”

Despite the difficulties, the couple sought to maintain normalcy and prosperity. They stay active, running half marathons and walking every day, changing their plans to suit Mr. Markham’s energy levels.

“From the outside, you don’t look sick,” Mr. Markham said.

“But inside you’re falling apart, you’re constantly tired. I’m working hard to regain my strength.”

He retired from work as a process engineer in late 2023 after fatigue made commuting and daily tasks impossible.

“A 30-minute drive to work took me two hours because I had to sleep all the time. I loved my job, but I couldn’t do it anymore,” Mr. Markham said.

Mrs Markham also retired from her mental health role to become her husband’s full-time carer.

Despite these life changes, the couple remains committed to their community. They join Myeloma Australia support groups, share stories and volunteer where possible.

“We’re trying to do the best we can,” Mr. Markham said.

“Earlier this year we raised a few thousand dollars by running a half marathon and I also did the 10km leg of the Melbourne marathon.

“It’s not the same speed as before, but it keeps us moving and focused.”

Despite the dire prognosis, new treatment options offer patients new hope.

Blenrep (belantamab mafodotin), recently approved in Australia, has been described as a “Trojan horse” treatment because it directly targets myeloma cells and kills them from the inside.

It is the first drug of its kind approved for multiple myeloma and can be used as part of a triple combination in eligible adults after at least one previous treatment.

The application for reimbursement through the Pharmaceutical Benefits Scheme (PBS) will be considered in November.

Recently, the federal government added the immunotherapy drug Daratumumab (Darzalex) to the PBS as a first-line treatment for patients who cannot undergo a stem cell transplant.

The therapy, which previously cost $440,000 for a full course, will now be available for as little as $31.60 per month, significantly increasing access for approximately 1,200 patients each year.

Advocates welcomed the listing as a long-awaited breakthrough, noting that myeloma becomes harder to treat with each relapse and that early, effective treatment can significantly improve quality of life.

“I’m always on the lookout for new treatments and clinical trials. I’ve made myself available to anything that could prolong my life and quality of life,” Mr. Markham said.

It is particularly interested in clinical research, including its “successor” programme, which offers five-year research studies testing new treatments not yet available in Australia.

“It’s a commitment, but it also saves time,” he said.

“I believe there is a cure on the horizon, hopefully within 10 years, and I would like to live long enough to see it or at least contribute to the research that will make it possible.”

Blenrep is part of a growing international pipeline of new treatments with approvals in Canada, the UK, the US, Europe and Japan.

Administered as a 30-minute outpatient infusion, it delivers the anti-cancer drug directly to myeloma cells while also helping the immune system recognize and clear the disease.

Experts say approving new treatments is critical given the nature of multiple myeloma.

Hang Quach, director of clinical hematology at St Vincent’s Hospital, said initial treatment usually involves a combination of three or more treatments.

“But most people will eventually find their myeloma returns or becomes unresponsive. So having a new ‘Trojan horse’ treatment like Blenrep, which targets myeloma cells in a completely different way, represents a significant advance for patients who need new options in the second line of treatment,” Professor Quach said.

Myeloma Australia chief executive Mark Henderson said the myeloma community was growing and so was the need for new treatments.

“Unfortunately, less than 60 per cent of these patients survive five years after diagnosis, highlighting the urgent need for new treatment approaches,” Mr Henderson said.

“Blenrep offers a new option and we welcome its availability for eligible patients.”

For the Markhams, each breakthrough brings more than just medical advancement.

“Every new treatment is another chance,” Mr. Markham said.