What Is Multiple Myeloma?
Multiple myeloma is a blood cancer that begins in the bone marrow’s plasma cells. Normal plasma cells that produce antibodies to defend your body against infections can be found in the healthy bone marrow. In multiple myeloma, plasma cells are converted into malignant multiple myeloma cells, which grow uncontrollably and generate excessive amounts of an abnormal antibody called M protein.
The stages of Multiple myeloma are based on four factors:
- The body’s albumin (a type of blood protein) concentration
- Blood beta-2-microglobulin (another blood protein) concentration
- LDH (a cell enzyme) concentration in the blood, and
- Cancer’s specific gene abnormalities (cytogenetics)
Symptoms of Multiple Myeloma
Myeloma sometimes has no symptoms. When myeloma is further advanced, symptoms might include:
- Spine or rib discomfort
- Fragile bones
- Fever for no apparent cause
- Recurrent infections
- Bruising or bleeding readily
- Breathing difficulties
- Arm or leg weakness and
- Extreme exhaustion.
Risk factors and causes of Multiple Myeloma
This condition primarily affects older adults, with the average age of diagnosis being 66. Other risk factors include:
- The most significant risk for myeloma onset is age. Most patients who receive this cancer diagnosis are at least 65 years old. Rarely does this illness affect anyone under the age of 45. Those under 35 are diagnosed less than 1% of the time.
- Men are more likely to acquire multiple myeloma than women.
- A person is more likely to get myeloma if they have a sibling or parent with the disease.
- Obesity and overweight are also associated with an increased risk of multiple myeloma.
- Individuals with solitary plasmacytoma (an early-stage plasma cell malignancy) are more likely to develop multiple myeloma than people who do not have these conditions.
- In rare instances, exposure to X-rays or other ionizing radiation may increase the chance of developing myeloma.
Complications of Multiple myeloma
The most common complications brought about by multiple myeloma are mentioned below:
- Bone problems: Myeloma cells interfere with the bone-strengthening cells. Bones are continuously rebuilt to maintain their strength. Two types of bone cells cooperate to maintain strong and healthy bones: Osteoclasts break down old bone, while osteoblasts form new bone. A chemical produced by myeloma cells directs the osteoclasts to accelerate the breakdown of bone. As a result, old bone is degraded without being replaced by new bone, leaving the bones prone to breakage. Bone fractures are a severe issue for myeloma patients.
- Infections: The production of antibodies to fight against diseases is prevented because the myeloma cells crowd out the healthy plasma cells. The myeloma cells’ abnormal antibody is ineffective in preventing infections.
- Kidney problem: Myeloma cells produce an antibody that can deposit in and damage the kidneys, causing renal failure.
Diagnosis of Multiple myeloma
Multiple myeloma can be challenging to diagnose because it often presents vague or non-specific symptoms in its early stages. Here are the key steps involved in the diagnosis of multiple myeloma.
1. Blood test: It is one of the most important tests in diagnosing multiple myeloma, which includes various parameters that must be assessed.
- Complete blood count (CBC): A CBC measures the number of red blood cells, white blood cells, and platelets in the blood. Multiple myeloma can cause anemia and other abnormalities in blood cell counts.
- Blood chemistry panel: This panel includes an assessment of kidney function, calcium levels, and other metabolic markers, as multiple myeloma can affect these parameters. It can cause you to have a higher calcium level and deranged kidney function.
- Serum immunofixation (IFE): Serum immunofixation is used further to characterize the type of M protein in the blood.
2. Electrophoresis: Electrophoresis is a technique commonly used to diagnose multiple myeloma where an electric field is applied to a gel matrix containing the patient’s serum or urine. Proteins migrate through the gel at different rates based on their charge and size, resulting in distinct bands or peaks on the electrophoresis graph. Specifically, two types of electrophoresis tests are often performed to assess the presence and characteristics of abnormal proteins, including monoclonal or M proteins, which are a hallmark of multiple myeloma. There are two types of electrophoresis:
- Serum Protein Electrophoresis (SPEP): SPEP is a blood test that separates and quantifies the various proteins in the serum (the liquid portion of blood). The electrophoretic pattern obtained from SPEP can help identify the presence of a monoclonal spike or band, which is indicative of M proteins (M proteins are proteins that are produced by the cancerous plasma cells). The test provides information about the type and amount of M protein in the blood, aiding in diagnosing and monitoring multiple myeloma.
- Urine Protein Electrophoresis (UPEP): UPEP is a urine test that separates and quantifies proteins found in the urine. It detects and quantifies M proteins that may be excreted in the urine, a condition known as Bence Jones proteinuria. UPEP is particularly useful when the M protein level in the blood is low, as it may be more readily detected in the urine.
3. Bone marrow Aspiration and Biopsy: A bone marrow aspiration and biopsy are crucial for confirming the diagnosis of multiple myeloma. A sample of bone marrow is usually taken from the hipbone (pelvic bone) and examined under a microscope. This helps identify abnormal plasma cells and assess the extent of bone marrow involvement. A diagnosis of multiple myeloma requires a plasma cell tumor diagnosed by biopsy or at least 10% of the bone marrow to contain plasma cells.
4. Imaging studies: X-rays, CT scans, MRI scans, or PET scans may be performed to evaluate the bones and detect any bone lesions or fractures caused by multiple myeloma. These imaging studies can also help determine the stage of the disease.
Treatment of Multiple Myeloma
Myeloma is difficult to cure, requiring different therapy when the disease reappears. Not everyone with myeloma needs immediate treatment; for instance, the illness may not bother anyone. If you do not require treatment, you will be monitored for any warning signals of progressive cancer. The most often-used treatment choices are listed below:
1. Local treatment: Certain medical procedures are known as local therapies. This indicates that the tumor is treated without having an impact on the body as a whole. While they could be used in other circumstances, these therapies are more likely beneficial for tumors in an earlier stage (less advanced).
- Surgery: While surgery is rarely used to treat multiple myeloma, it is occasionally performed to remove single plasmacytomas (tumors of plasma cells in soft tissues).
- Radiation therapy: Radiation may be used to treat myeloma-damaged bone that is causing pain or may soon break but has not responded to chemotherapy or other medications.
2. Systematic treatment:
- Drug therapy: Multiple myeloma can be treated with a wide variety of medications such as Chemotherapy Corticosteroids (steroids), Immunomodulating agents, Proteasome inhibitors, Monoclonal antibodies, Nuclear export inhibitors, Bispecific T cell engager (BiTE), Intravenous immunoglobulin (IVIG), and treatment for anemia.
- CAR T-cell Therapy: Cancer immunotherapy includes a novel therapy called chimeric antigen receptor (CAR) T-cell treatment. It helps the body’s immune system in locating and eliminating cancer cells.
- Stem Cell Transplant: In order to destroy the bone marrow cells before a stem cell transplant, the patient receives high-dose chemotherapy. The patient is then given fresh, healthy stem cells that can produce blood. The new stem cells were derived from bone marrow in the early days of stem cell transplants. Hence, it is known as a “bone marrow transplant.”
3. Supportive Treatments: Supportive care aims to prevent or relieve symptoms. However, it doesn’t cure cancer. Regardless of the cancer stage or the therapeutic aim, the primary objective of this type of therapy is to increase the patient’s comfort and quality of life.
Multidisciplinary approach to treatment:
You must visit your doctor if you have any of the above-mentioned symptoms or concerns about your health. You might have to consult various medical professionals depending on your treatment options.
⇒ An orthopedic surgeon is a medical professional who performs surgery to cure bone problems.
⇒ A radiation oncologist is a physician who uses radiation treatment to treat cancer.
⇒ A medical oncologist is a physician who uses targeted therapies or chemotherapy to treat cancer.
⇒ A bone marrow transplant specialist is a cancer doctor performing bone marrow transplants.
Questions for your doctor
- Has my cancer spread beyond where it started?
- Will I need other tests before we can decide on treatment?
- What is the stage of my multiple myeloma, and what does this mean for my prognosis and treatment options?
- What are the treatment options for multiple myeloma, and what are the benefits and potential side effects?
- What lifestyle changes can I make to improve my overall health?
- How often will I need to undergo tests and follow-up appointments to monitor my condition, and what should I expect during these visits?
- Are any support groups or resources available for people with multiple myeloma and their caregivers?
Bidhusi Pokharel, MD
Gauri Adhikari, MD
