Multiple Myeloma

Multiple Myeloma

Multiple myeloma is a type of cancer that affects plasma cells, which are a type of white blood cell that produces antibodies to help fight infections. In multiple myeloma, abnormal plasma cells begin to grow uncontrollably in the bone marrow, leading to the production of large quantities of abnormal proteins.

These abnormal proteins can cause damage to the kidneys and other organs, leading to a range of symptoms. Multiple myeloma is a complex disease, and there are several different subtypes based on the specific characteristics of the cancer cells. 

Causes and Risk Factors

The exact cause of multiple myeloma is not known, but there are several known risk factors that increase the likelihood of developing the disease. These risk factors include –

1. Age -Multiple myeloma is more common in older adults, with the majority of cases diagnosed in people over the age of 65.
2. Gender – Men are slightly more likely than women to develop multiple myeloma.
3. Race and ethnicity – Multiple myeloma is more common in African Americans and people of African descent than in Caucasians.
4. Family history – Having a first-degree relative (such as a parent or sibling) with multiple myeloma increases the risk of developing the disease.
5. Exposure to radiation – Exposure to high levels of radiation, such as from radiation therapy for other cancers or nuclear accidents, may increase the risk of developing multiple myeloma.

Multiple Myeloma

6. Exposure to certain chemicals – Exposure to certain chemicals, such as benzene and pesticides, may increase the risk of developing multiple myeloma.

7. Weakened immune system – People with weakened immune systems, such as those with HIV/AIDS or who have received an organ transplant, are at higher risk for developing multiple myeloma.

Having one or more risk factors does not mean that a person will definitely develop multiple myeloma. Many people with multiple myeloma have no known risk factors, and many people with risk factors never develop the disease.

Symptoms

The symptoms of multiple myeloma can vary depending on the stage of the disease and the extent of the cancer. Some people with multiple myeloma may have no symptoms at all, while others may experience a range of symptoms, including –

1. Bone pain and fractures – Multiple myeloma can cause bone pain, particularly in the spine, ribs, and hips. It can also weaken bones and lead to fractures.
2. Fatigue – Multiple myeloma can cause fatigue and weakness, often due to anemia.
3. Recurrent infections – Multiple myeloma can suppress the immune system, leading to an increased risk of infections.
4. Nausea, vomiting, and constipation – Multiple myeloma can affect the digestive system, leading to symptoms such as nausea, vomiting, and constipation.
5. Kidney problems – Multiple myeloma can cause kidney damage and lead to symptoms such as increased thirst, frequent urination, and swelling in the legs and feet.
6. Abnormal bleeding – Multiple myeloma can affect blood clotting, leading to abnormal bleeding and bruising.
7. Neurological symptoms – In rare cases, multiple myeloma can affect the nervous system, leading to symptoms such as numbness, tingling, and weakness.

These symptoms can be caused by many different conditions, and having one or more of these symptoms does not necessarily mean that a person has multiple myeloma. If you are experiencing any of these symptoms, it’s important to see a doctor for an evaluation.

Diagnosis and Tests

Diagnosing multiple myeloma usually involves a combination of tests and procedures, including –

1. Blood and urine tests – Blood and urine tests can detect the abnormal proteins produced by myeloma cells, such as M proteins and light chains.
2. Bone marrow biopsy – A bone marrow biopsy involves removing a small sample of bone marrow from the hipbone or breastbone and examining it under a microscope to look for myeloma cells.
3. Imaging tests – Imaging tests such as X-rays, CT scans, PET scans, and MRI scans can help identify areas of bone damage and the extent of the disease.

Some of the imaging tests that are commonly used to diagnose and monitor multiple myeloma include –

• X-rays – X-rays can detect bone damage caused by multiple myelomas, such as osteolytic lesions (holes in the bone) or fractures.
• CT scans – CT scans use X-rays to create detailed images of the inside of the body, which can help identify bone damage, as well as soft tissue abnormalities and lymph node enlargement.
• MRI scans – MRI scans use magnetic fields and radio waves to create detailed images of the body, which can help identify areas of bone and soft tissue damage caused by multiple myeloma.
• PET scans – PET scans use a radioactive tracer to highlight areas of the body that are metabolically active, such as cancer cells. PET scans can be used to identify areas of multiple myeloma activity throughout the body.
• Bone scans – Bone scans involve injecting a small amount of radioactive material into the bloodstream, which is taken up by bone cells. The radiation emitted by the radioactive material can be detected by a scanner and used to create images of the bones, which can help identify areas of bone damage caused by multiple myeloma.

4. Ultrasonography – Ultrasonography uses high-frequency sound waves to create images of the body’s internal structures. This imaging test can be used to identify soft tissue abnormalities and to evaluate the kidneys for damage caused by multiple myeloma.
5. Other tests – Other tests such as a complete blood count (CBC), kidney function tests, and blood clotting tests may also be done to evaluate the patient’s overall health.

The International Myeloma Working Group has developed diagnostic criteria for multiple myeloma, which include the presence of one or more of the following –

1. M protein in the blood or urine
2. Clonal plasma cells in the bone marrow
3. Evidence of end-organ damage, such as bone lesions, anemia, kidney damage, or hypercalcemia.

If multiple myeloma is diagnosed, additional tests may be done to determine the extent of the disease and to help guide treatment decisions. These tests may include additional imaging tests, genetic testing of the myeloma cells, and tests to evaluate the patient’s overall health and ability to tolerate treatment.

Treatments

The treatment of multiple myeloma depends on several factors, including the stage of the disease, the patient’s age and overall health, and the presence of any other medical conditions. Treatment options may include –

1. Chemotherapy – Chemotherapy involves the use of drugs to kill cancer cells. Chemotherapy may be given alone or in combination with other treatments.
2. Targeted therapy – Targeted therapy drugs are designed to specifically target cancer cells while sparing healthy cells. These drugs may be used in combination with chemotherapy.
3. Immunotherapy – Immunotherapy drugs stimulate the immune system to attack cancer cells. Immunotherapy may be used alone or in combination with other treatments.
4. Stem cell transplant – A stem cell transplant involves replacing the patient’s diseased bone marrow with healthy stem cells. This treatment is typically reserved for patients with more advanced disease.
5. Radiation therapy – Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Radiation therapy may be used to relieve pain or other symptoms caused by multiple myeloma.
6. Surgery – Surgery is rarely used to treat multiple myeloma. However, in some cases, surgery may be used to remove a plasmacytoma (a localized mass of abnormal plasma cells) or to stabilize a bone that has been weakened by multiple myeloma.

The treatment of multiple myeloma is typically divided into two phases: induction therapy and maintenance therapy. Induction therapy is designed to kill as many myeloma cells as possible and bring the disease under control. Maintenance therapy is given to help prevent the disease from coming back.

The choice of treatment(s) used to manage multiple myeloma depends on several factors, including the stage of the disease, the patient’s overall health, and the preferences of the treating physician.

Outlook

The outlook for multiple myeloma varies depending on several factors, including the stage of the disease, the age and overall health of the patient, and the response to treatment.

Overall, multiple myeloma is considered a treatable but incurable cancer. However, many patients are able to achieve remission (the absence of disease) and live for many years with the disease. The survival rate for multiple myeloma has improved in recent years due to the development of new treatments and therapies.

The International Staging System (ISS) is often used to stage multiple myeloma and predict patient outcomes. Patients with stage I multiple myeloma typically have the best outlook, with a median survival of about 62 months. Patients with stage III multiple myeloma typically have the worst outlook, with a median survival of about 29 months.

Patients with multiple myeloma should work closely with their healthcare team to develop a treatment plan that is tailored to their specific needs and circumstances. Regular follow-up care is also important to monitor the progression of the disease and make adjustments to the treatment plan as needed.