Multiple myeloma

Multiple Myeloma

Multiple myeloma is a type of cancer that affects plasma cells. Plasma cells are a type of white blood cells found in bone marrow. The bone marrow is the soft tissue inside most of our bones that produces blood cells. In the bone marrow, plasma cells make antibodies, which are proteins that help our body to fight against diseases and infections.

Multiple myeloma occurs when an abnormal plasma cell develops in the bone marrow and reproduces itself very quickly. The rapid reproduction of malignant, or cancerous, myeloma cells eventually exceeds the production of healthy cells in the bone marrow. As a result, the cancerous cells begin to accumulate in the bone marrow, replacing the healthy white blood cells and red blood cells.

Like healthy blood cells, cancerous cells try to make antibodies. However, they can only produce abnormal antibodies called monoclonal proteins, or M- proteins. When these harmful antibodies collect in the body, they can cause kidney damage and other serious problems.

According to Stanford University, multiple myeloma is rare, accounting for only one percent of all cancer cases in the United States. About 5 people out of 100,000 are diagnosed with this type of cancer each year.

How is multiple myeloma diagnosed?

• Blood and urine tests
• Biopsy
• X-rays, MRI scans, or CT scans

Types of multiple myeloma

There are two main types of multiple myeloma. They’re categorized by their effect on the body:

• An indolent myeloma causes no noticeable symptoms. It usually develops slowly and doesn’t cause bone tumors. Only small increases in M protein and M plasma cells are seen.
• A solitary plasmacytoma causes a tumor to form, typically in bone. It usually responds well to treatment, but needs close monitoring

What are the symptoms of multiple myeloma?

The symptoms of multiple myeloma vary depending on the person. Initially, symptoms may not be noticeable. However, as the disease progresses, most people will experience at least one of four major types of symptoms. These symptoms are generally referred to by the acronym CRAB, which stands for:

• calcium
• renal failure
• anemia
• bone damage

High levels of calcium in the blood come from affected bones leaking calcium. Too much calcium can cause:

• extreme thirst
• nausea
• vomiting
• upset stomach
• loss of appetite

Confusion and constipation are also common symptoms of increased calcium levels.

Kidney failure can be caused by high levels of M protein in the body.

Anemia is a condition in which the blood does not have enough healthy red blood cells to carry oxygen to the rest of the body. This happens when cancerous cells outnumber red blood cells in the bone marrow. Anemia often causes fatigue, dizziness, and irritability.

Bone injuries and fractures occur when cancerous cells invade the bone and bone marrow. These lesions appear as holes in X-ray images. They often cause bone pain, especially in the:

• back
• pelvis
• ribs
• skull

Additional symptoms of multiple myeloma may include:

• weakness or , especially in the legs
• unintentional weight loss
• confusion
• problems with urination
• nausea
• vomiting
• repeated infections
• vision loss or vision problems

What causes multiple myeloma?

The exact cause of multiple myeloma is unknown. However, it starts with one abnormal plasma cell whose multiplication rate in the bone marrow is many more times than that of a normal cell. The resulting cancerous myeloma cells eventually impair the production of healthy cells

What are the risk factors for multiple myeloma?

People have a higher risk of developing multiple myeloma if they’re:

• male
• over age 50
• African-American
• overweight or obese
• exposed to radiation
• employed in the petroleum industry

Another risk factor for multiple myeloma is a history of monoclonal gammopathy of undetermined significance (MGUS). This is a condition that causes plasma cells to produce M proteins. It usually does not cause any problems, however, MGUS can sometimes develop into multiple myeloma over time.

How is multiple myeloma diagnosed?

Doctors often detect multiple myeloma before the onset of any symptoms. . Routine physical exams, blood tests, and urine tests can uncover presence of this cancer.

More tests will be needed if the doctor finds signs of myeloma when a person does not show symptoms. Using the following tests, the doctor can monitor the progression of the disease and determine whether treatment is required or not

Blood and urine tests

Blood and urine tests are used to check for M proteins. These proteins may be caused by multiple myeloma or by other conditions. Cancerous cells also make a protein called beta-2 microglobulin, which can be found in the blood. Blood tests can also be used to assess:

• the percentage of plasma cells in the bone marrow
• kidney function
• blood cell counts
• calcium levels
• uric acid levels

Imaging tests

X-rays, MRI scans, or CT scans can be used to determine whether bones have been damaged by multiple myeloma.

Biopsy

During a biopsy, the doctor removes a small sample of bone marrow with a long needle. Once a sample is obtained, it can be checked for cancerous cells in a laboratory. Various tests can determine the types of abnormalities in the cells and how quickly the cells are multiplying.

These types of tests are used to determine whether you have multiple myeloma or any other disease. If multiple myeloma is found, the tests can show how far it has progressed. This is known as staging the cancer.

Staging

Multiple myeloma is staged by looking at:

• blood cell counts
• protein levels in blood and urine
• calcium levels in the blood

The results of other diagnostic tests may also be used.

There are two ways to stage multiple myeloma. The Durie-Salmon system determines the levels of M protein, calcium, and red blood cells as well as the degree of bone damage. The International Staging System is based on the levels of blood plasma and beta-2 microglobulin.

Both systems divide the condition into three stages, with the third stage being the most severe. Staging helps your doctor determine your outlook and treatment options.

How is multiple myeloma treated?

There is no cure for multiple myeloma. However, there are treatments that can help ease the pain, reduce complications, and slow the progression of the disease. Treatments are only given if the disease is getting worse.

The doctor is unlikely to suggest treatment if a patient does not show any symptoms. Instead, the doctor will closely monitor the patient for signs that the disease is progressing. This often involves regular blood and urine tests.

If you need treatment, common options include the following:

Targeted therapy

Targeted therapy medications block a chemical present in myeloma cells that destroys proteins, causing the cancer cells to die. The drugs that may be used during targeted therapy include bortezomib (Velcade) and carfilzomib (Kyprolis). Both are administered intravenously

Biological therapy

Biological therapy medications use your body’s immune system to attack myeloma cells. The pill form of thalidomide (Thalomid), lenalidomide (Revlimid), or pomalidomide (Pomalyst) is usually used to boost the immune system.

Lenalidomide is similar to thalidomide, and has fewer side effects. It also appears to be more potent than thalidomide.

Chemotherapy

Chemotherapy is an aggressive form of drug therapy that helps kill fast-growing cells, including myeloma cells. Chemotherapy drugs are often given in high doses, especially before a stem cell transplant. The medications may be given intravenously or taken in pill form.

Corticosteroids

Corticosteroids, such as prednisone and dexamethasone, are often used to treat myeloma. They can balance the immune system by reducing inflammation in the body, so they are often effective in destroying myeloma cells. They can be taken in pill form or given intravenously.

Radiation therapy

Radiation therapy uses strong beams of energy to damage myeloma cells and stop their growth. This type of treatment is sometimes used to kill myeloma cells quickly in a certain area of the body.

Stem cell transplants

Stem cell transplants involve replacing diseased bone marrow with healthy bone marrow from a donor. Before the procedure, blood-forming stem cells are collected from a patient’s blood. The multiple myeloma is then treated with radiation therapy or with high doses of chemotherapy. Once the diseased tissue are destroyed, the stem cells can be infused into a patient’s body, where they move into the bones and start rebuilding bone marrow.

Alternative medicine

Alternative medicine has become a popular way to cope with the symptoms of multiple myeloma, however it cannot treat multiple myeloma, but can help in ameliorating the disease condition with the following therapies:

• acupuncture
• aromatherapy
• massage
• meditation
• relaxation methods

Discuss any alternative therapies with your doctor before trying them to ensure they are safe for your health.

What are the complications associated with multiple myeloma?

Multiple myeloma may cause many complications, but they are usually treatable:

• Back pain can be treated with medications or a back brace.
• Kidney complications are treated with dialysis or a kidney transplant.
• Infections can be treated with antibiotics.
• Bone loss can be slowed or prevented with drug therapy.
• Anemia can be treated with erythropoietin. This medication stimulates the body to produce more red blood cells.

Coping with multiple myeloma

If a patient has been diagnosed with multiple myeloma diagnosis, he/she might find it helpful to do one or more of the following:

Learn more about multiple myeloma

A patient can educate himself/herself by learning about multiple myeloma so that an informed decision can be taken about treatment. He/she should talkT to a specialist doctor about treatment options and the side effects of treatment.

The National Cancer Institute and International Myeloma Foundation can also provide a patient with more information about multiple myeloma.

Establish a support system

The patient should establish a support system by gathering a group of friends and family members who can lend a helping hand or emotional support when the need arises. Support groups can also be helpful and may be found online. If a patient prefers to meet a support group in person, visit the American Cancer Society website to find groups in your area.

Set reasonable goals

The patient should stay motivated by setting reasonable goals that give him/her a sense of control over his/her condition.Do not set goals that are too lofty,. doing so can lead to exhaustion and frustration. For example, a patient may not be able to work a full 40 hours per week, but he/she may still be able to work part time.

Focus on your overall health

The patient should eat healthy foods and get enough sleep. He/she can do low-intensity exercises, such as walking or yoga, a couple of times per week. Keeping one’s body and mind as healthy as possible can help a patient cope better with the stress and fatigue one may experience with cancer. The patient should ensure that he/she gets enough time to rest and recover, without overloading his/her schedule.

What’s the outlook for people with multiple myeloma?

Patients who have been recently been diagnosed of multiple myeloma may not experience symptoms for several years. Once the disease has progressed and symptoms do occur, most patients respond well to treatment. However, serious complications can develop, even after years of successful treatment.

An exact timetable for the disease is difficult to predict, but according to the American Cancer Society, the median survival rates in patients for the three stages of multiple myeloma are:

It is important to keep in mind that these are general estimates based on previous outcomes of numerous patients who have had multiple myeloma. A patient’s specific outlook depends on various factors, including his/her age, overall health, and how well his/her cancer responds to treatment. The patient should speak to the doctor about his/her particular situation to learn more.