After being diagnosed at UConn Health with an exceptionally rare form of multiple myeloma, 86-year-old Richard Casciano Sr. made a remarkable recovery, regaining his independence and quality of life through innovative treatment and compassionate care.
Kristina Valladares, Katherine Hooper, Richard Casciano and Dr. Swarup Kumar (Tina Encarnacion/UConn Health)
Just a few months ago, Richard Casciano Sr. was in constant pain, losing weight rapidly, and struggling to walk.
Today, the 86-year-old is back to doing what he loves, socializing with friends, planning future travel, and even talking about golfing and deep-sea fishing.
His remarkable turnaround began with a visit to UConn John Dempsey Hospital's Emergency Department, where what initially appeared to be chest and back pain led physicians to discover one of the rarest forms of multiple myeloma.
"We are so grateful," says Richard's daughter, Gemma Casciano. "The quality of life we wanted for him is exactly what he has now. He's interacting with people again, walking around, and enjoying life. It's beyond what any of us expected."
Richard had already overcome significant health challenges, including a major heart attack the year before. But in early 2026, his family noticed a rapid decline. He was experiencing severe back and chest pain, losing weight, sleeping more than usual, and becoming increasingly weak.
On Feb. 18, Richard came to UConn Health's Emergency Department seeking answers. Testing revealed broken bones and lesions that prompted further investigation. The findings ultimately led to a diagnosis of IgM multiple myeloma, an exceptionally rare subtype of blood cancer.
"IgM multiple myeloma accounts for only about 0.5% of all myeloma cases," says Dr. Swarup Kumar, hematologist-oncologist at the Carole and Ray Neag Comprehensive Cancer Center at UConn Health. "In my eight years at UConn Health, this was the first case I had personally encountered."
Kumar credits the collaborative efforts of multiple teams, especially the medical hospitalist & resident team who were involved in Richard's care and their attention to detail that led to the diagnosis.
"The combination of imaging findings and abnormal blood work prompted further evaluation," he says. "Had those findings been overlooked, it's possible the diagnosis could have been missed."
A bone marrow biopsy confirmed the diagnosis, and Richard required urgent treatment to stabilize his condition.
The diagnosis came with difficult choices. Richard was already managing heart disease, frailty, and early Alzheimer's disease. The family's primary goal wasn't simply extending life-it was preserving quality of life.
"We really had to think about it," Gemma recalls. "The first treatment wasn't working, and Dad had been through so much. But if there was a chance he could get back to enjoying life again, we wanted to try."
Following a comprehensive assessment of possible therapies, Kumar and his team selected teclistamab, an advanced bispecific T‑cell engager (BiTE) therapy, engineered to attack the cancer effectively while employing safeguards to limit and manage side effects.
"At 86 years old, with multiple medical issues, these are never easy decisions," Kumar says. "But Richard made it clear that he wanted a chance. He told me, 'If you can keep me alive and keep me functional, that's what I want.'"
The results exceeded everyone's expectations.
At diagnosis, Richard's IgM protein level measured 9,925 mg/dL-more than 30 times the upper limit of normal. There was no significant response with the first line of treatment. However, after the new therapy was initiated, those levels rapidly fell. Most recently, they reached just 11 mg/dL, placing them well below the normal range.
"We saw a rapid decline in the protein levels almost immediately," Kumar says. "That told us he was responding exceptionally well to treatment."
The improvement wasn't limited to laboratory results. Richard gained weight, his pain disappeared, and his mobility returned. After requiring a wheelchair and extensive assistance, he is now walking independently around his assisted living community and participating in daily activities.
"He had gone from not being able to walk and being in tremendous pain to literally bopping around with his walker," Gemma says. "He's doing his thing again."
The transformation has been remarkable for a man who only months earlier had spent weeks moving between the hospital and rehabilitation. His family had been forced to make difficult decisions about his care and living arrangements as his health rapidly deteriorated.
"My dad is a fighter," Gemma says. "He worked hard his entire life and has always pushed through challenges. I think that's part of why he's done so well."
Kumar says seeing those changes firsthand has been especially rewarding.
"These are the moments that remind us why we do what we do," he says. "The goal is always to choose the treatment that best aligns with the patient's needs and goals. When you can help someone regain their quality of life, that's incredibly meaningful."
Today, Richard continues to receive treatment and monitoring at UConn Health. His family is focused on enjoying the time they have together and celebrating milestones that once seemed uncertain.
"Our elderly loved ones are just as important as anyone else," Gemma says. "Quality of life matters. Seeing my dad get this chance means everything to our family."
Richard, meanwhile, is focused on the future. His wish list includes traveling, golfing, and spending time with family-and if he has his way, a deep-sea fishing trip may not be far behind.
For Kumar, Richard's story highlights the impact of innovative therapies, thoughtful decision-making, and personalized care.
"Myeloma treatments have come a long way," Kumar says. "What's most important is finding the right treatment for the right patient. Richard's story is a wonderful example of that."
Kumar would also like to credit nurse practitioner Katherine Hooper, nurse Kristina Valladares, the inpatient hematology team, infusion RNs and the support staff at the Neag Cancer Center for their excellent and compassionate care of this individual.
