What is Mutiple Myeloma ?
Multiple myeloma is often referred to simply as myeloma. It is a type of cancer that starts in the plasma cells of the bone marrow. These are protein-making cells which normally make all of the different kinds of proteins that comprise the antibodies of the immune system. In multiple myeloma, the plasma cells undergo what is referred to as a malignant transformation and thereby become cancerous. These myeloma cells stop making different forms of protein in response to the immune system’s needs and instead start to produce a single abnormal type of protein referred to as a monoclonal or M protein. Multiple myeloma plasma cell populations accumulate and these collections of cells called plasmacytomas can erode the hard outer shell or cortex of the bone that normally surrounds the marrow. These weakened bones show thinning of the bone such as is seen in nonmalignant osteoporosis or what appear to be punched out or lytic bone lesions. These lesions may cause pain and fractures of the bones so damaged.
What causes multiple myeloma?
What triggers plasma cells to become malignant in multiple myeloma is not known.
What are multiple myeloma symptoms and signs?
The following is a list symptoms and signs of multiple myeloma:
- Nerve damage
- Enlarged tongue (macroglossia)
- Bone tenderness or pain
- Weakness or tiredness
- Pathologic bone fractures
- Back pain
- Spinal Cord Compression
- Kidney failure and/or damage
- Loss of appetite and weight loss
- Leg swelling
How do health-care professionals diagnose multiple myeloma?
- In many patients, multiple myeloma is first suspected when a routine blood test shows an abnormal amount of protein in the bloodstream or an unusual stickiness of red blood cells causing them to stack up almost like coins in a pattern called rouleaux, an unusual formation for red blood cells.
- The doctor will do a history and physical exam, looking for signs and symptoms of multiple myeloma. If multiple myeloma is suspected, several studies help confirm the diagnosis.
- A Bone marrow aspiration and biopsy is most commonly done from the large bones of the pelvis to confirm the diagnosis. Cells obtained from the marrow are studied by a pathologist to determine if there are abnormal types or numbers of cells. A sample of the bone marrow aspirate is also studied for more detailed characteristics such as the presence or absence of abnormal numbers or types of chromosomes by what is called cytogenetic testing. Other molecular testing may be done on the marrow sample as well. The bone marrow biopsy can assess the concentrations of cells in the marrow and the presence of abnormal invasive growth of cellular elements
- Blood testing and urine testing by several methods can determine levels and types of abnormal protein produced. This is called as M protein. It is measured at diagnosis and during follow up to see the response to treatment.
- Most clinicians will use X-ray studies to identify skeletal lesions and MRI for spinal, paraspinal, or spinal cord lesions in multiple myeloma. In addition, several routine tests (CBC, sedimentation rate, BUN, C-reactive protein, Serum free light chain ratio, Immunofixation electrophoresis etc.) are also done.
How is multiple myeloma treated?
The treatment for multiple myeloma may include:
- Chemotherapy and other drugs
- Stem cell transplant
It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.
Chemotherapy and other drugs for multiple myeloma
Chemotherapy (chemo) is the use of drugs to destroy or control cancer cells. These drugs can be taken by mouth or given in a vein or a muscle. They enter the bloodstream and reach all areas of the body, making this treatment useful for cancers such as multiple myeloma that often spread widely.
There are many different types of drugs are used to treat multiple myeloma.
Chemo drugs that may be used to treat multiple myeloma include
- Liposomal doxorubicin
Combinations of these drugs are more effective than any single drug. Often these drugs are combined with other types of drugs like corticosteroids or immunomodulating agents (drugs that will change the patient’s immune response).
Chemo side effects
Chemo drugs kill cancer cells but also can damage normal cells. They are given carefully to avoid or reduce the side effects of chemotherapy. These side effects depend on the type and dose of drugs given and the length of time they are taken. Common side effects of chemotherapy include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Low blood counts
Chemotherapy often leads to low blood counts, which can cause the following:
- Increased risk of serious infection (from low white blood cell counts)
- Easy bruising or bleeding (from low blood platelets orthrombocytopenia)
- Feeling excessively tired or short of breath (from low red blood cells or anemia).
Most side effects are temporary and go away after treatment is finished.
Stem cell transplant for multiple myeloma
In a stem cell transplant, the patient gets high-dose chemotherapy to kill the cells in the bone marrow (including the myeloma cells). Then the patient receives new, healthy blood-forming stem cells. When stem cell transplants were first developed, the new stem cells came from bone marrow, and so this was known as a bone marrow transplant. Now, stem cells are more often gathered from the blood (a peripheral blood stem cell transplant).
Stem cell transplant is commonly used to treat multiple myeloma. Before the transplant, drug treatment is used to reduce the number of myeloma cells in the patient’s body
Stem cell transplants (SCT) are autologous and allogeneic.
For an autologous stem cell transplant, the patient’s own stem cells are removed from his or her bone marrow or peripheral blood before the transplant. The cells are stored until they are needed for the transplant. Then, the person with myeloma gets treatment with high-dose chemotherapy to kill the cancer cells. When this is complete, the stored stem cells are infused back into the patient’s blood.
This type of transplant is a standard treatment for patients with multiple myeloma. Still, while an autologous transplant can make the myeloma go away for a time (even years), it doesn’t cure the cancer, and eventually the myeloma returns.
Some doctors recommend that patients with multiple myeloma have 2 autologous transplants, 6 to 12 months apart. This approach is called tandem transplant. Studies show that this may help some patients more than a single transplant. The drawback is that it causes more side effects and so is riskier.
The early side effects from a stem cell transplant (SCT) are similar to those from chemotherapy and radiation, only more severe. One of the most serious side effects is low blood counts, which can lead to risks of serious infections and bleeding.
However majority of Myeloma patients tolerate transplant very well.