- The two cases demonstrate how specialist expertise can help navigate treatment-resistant disease and rare, difficult-to-diagnose conditions.
Cleveland Clinic Abu Dhabi has highlighted the importance of a personalized approach to complex plasma cell disorders through the treatment of two patients with markedly different journeys. The management of both cases demonstrates the importance of precise diagnosis, individualized treatment planning, and specialist experience.
The first patient, 53-year-old Monia, was living with high-risk multiple myeloma that continued to progress despite several advanced treatments. The second patient, 42-year-old Amir, was diagnosed with POEMS syndrome, a rare plasma cell disorder, after his symptoms were initially attributed to a neurological condition. While their conditions and treatment journeys differed significantly, both cases demonstrate how precise diagnosis, individualized treatment planning, and specialist expertise can play a critical role in managing complex plasma cell disorders.
“Plasma cell disorders can behave very differently from one patient to another, which means there is no single approach that works for everyone,” says Dr. Ajlan Al Zaki, Staff Physician, Hematology & Blood Cancer, Cancer Institute at Cleveland Clinic Abu Dhabi. “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.”
Reconsidering the treatment strategy for complex multiple myeloma
Monia, a Tunisian teacher and mother, 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.
By the time Monia came under Dr. Al Zaki’s care at Cleveland Clinic Abu Dhabi, 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.
“Treatment planning in multiple myeloma can be like a game of chess,” says Dr. Al Zaki. “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.”
Monia’s case illustrates an increasingly important consideration in complex cancer care: innovation is not only about access to newer therapies, but also about using the available treatment options in the right sequence for the individual patient. For patients whose disease has progressed through multiple lines of therapy, this requires specialist teams to continually reassess the disease, previous responses, and remaining treatment options.
Following treatment, masses associated with Monia’s myeloma decreased in size, and her clinical results improved—news she received on the eve of her birthday. “It was like a rebirth for me,” says Monia. “I am back to life and have started enjoying life again, cherishing every single day with my 10-year-old son and planning for the future.”
Diagnosing extremely rare POEMS syndrome
For Amir, a 42-year-old Pakistani resident of Sharjah, personalized care began with establishing the correct diagnosis. His symptoms started with stiffness and numbness in his feet. When Dr. Al Zaki reviewed Amir’s symptoms and investigation findings together, POEMS syndrome, a rare plasma cell disorder that can affect multiple systems in the body—was considered a possibility.
“Rare conditions such as POEMS require us to be clinical detectives,” says Dr. Al Zaki. “The individual symptoms may appear unrelated, so we have to put the clues together, identify what might be missing, and be willing to consider the ‘zebra’—the uncommon diagnosis that may not initially be obvious. Early identification and diagnosis are important in POEMS.”
Following further assessment, Amir was diagnosed with POEMS syndrome and began treatment. His experience demonstrates why access to specialist expertise is particularly important for rare diseases, for which symptoms may span different organ systems and resemble more common conditions. Recognizing these patterns and reaching the correct diagnosis can help patients move more quickly toward appropriate care.
“At a difficult and uncertain time, having a doctor who listened carefully and explained things clearly gave me a lot of confidence,” says Amir. “I am taking things one day at a time and remaining hopeful that I will gradually start to feel stronger.”
Personalized care for complex plasma cell disorders
Together, the two cases reflect Cleveland Clinic Abu Dhabi’s broader approach to complex cancer care: combining specialized expertise, advanced diagnostics, and multidisciplinary capabilities to provide individualized care for patients whose conditions may require treatment beyond conventional pathways.
“These cases reinforce why we need to look beyond the disease name and understand the individual patient in front of us,” says Dr. Al Zaki. “Whether we are identifying a rare diagnosis or determining what to do when multiple treatments have already been tried, our role is to examine every available clue and consider the strategies that may offer the patient the best path forward.”
Ranked the No. 1 hospital in the UAE in Newsweek’s World’s Best Hospitals 2026, Cleveland Clinic Abu Dhabi remains committed to combining specialist expertise with personalized, multidisciplinary care for even the most complex conditions.