What is Multiple Myeloma?

Dr Foram Bhuta

Dr Foram Bhuta

BDS (Bachelor of Dental Surgery), 10 years of experience

October 25, 2021 Cancer Hub 195 Views

English हिन्दी Bengali

What is the meaning of Multiple Myeloma?

Multiple myeloma is a type of cancer of the bone marrow in which the myeloma cells abnormally multiply and begin to replace normal plasma cells. 

Bone marrow is a spongy substance that is found in the center of the bones. Plasma cells are antibody-producing cells that are obtained from leukocytes (a type of white blood cell) known as B cells. 

Myeloma cells are abnormal plasma cells that may build up in the bone marrow to form a tumor. The tumor formed by these malignant plasma cells is called plasmacytoma, and the condition in which many such tumors develop is called multiple myeloma.

Multiple Myeloma adversely affects the body’s ability to produce antibodies which provide immunity to the body and weakens the bones.

Let us tell you in detail about multiple myeloma in today’s article.

  • What are the types of Multiple Myeloma?
  • What are the causes of Multiple Myeloma?
  • What are the risk factors of Multiple Myeloma?
  • What are the symptoms of Multiple Myeloma?
  • How is Multiple Myeloma diagnosed?
  • What are the treatments for Multiple Myeloma?
  • What are the complications of Multiple Myeloma and how are they treated?
  • How to care after Multiple Myeloma Treatment?
  • What are the risks of Multiple Myeloma Treatment?
  • How to prevent Multiple Myeloma?
  • What is the cost of Multiple Myeloma treatment in India?

What are the types of Multiple Myeloma?

The two main types of Multiple Myeloma are:

  • Indolent Myeloma: This type of multiple myeloma causes no noticeable symptoms. The development is usually slow, and it does not cause bone tumors. 
  • Solitary plasmacytoma: It is a type of multiple myeloma that leads to the formation of a tumor most commonly in the bone. Solitary plasmacytoma usually responds well to treatment, but it requires close monitoring.

What are the causes of Multiple Myeloma?

  • The exact cause of multiple myeloma is unknown.
  • It usually starts with one abnormal plasma cell that multiplies rapidly in the bone marrow.
  • The resulting myeloma cells are cancerous and do not have a normal life cycle, that is, instead of multiplying and dying they continue to divide indefinitely. 
  • This overwhelms the body and impairs the production of healthy cells.

What are the risk factors of Multiple Myeloma?

The following factors can increase the risk of developing multiple myeloma:

  • More common in men
  • Age above 50 years
  • African-American race
  • Obesity or overweight individual
  • Exposure to radiation
  • An employee in the petroleum industry
  • Family history of multiple myeloma
  • History of monoclonal gammopathy of undetermined significance (MGUS), which is a condition causing the abnormal plasma cells to produce M proteins in the blood. Multiple myeloma almost always starts as MGUS

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What are the symptoms of Multiple Myeloma?

Multiple myeloma may present the following symptoms:

  • Feeling tired and weak
  • Bone pain (especially back and ribs)
  • Weight loss
  • Excessive thirst
  • Frequent urination
  • Recurrent infections
  • Fever
  • Nausea 
  • Constipation
  • Repeated fractures
  • Visible lumps under the skin (Extramedullary plasmacytoma)

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How is Multiple Myeloma diagnosed?

The doctor will first physically examine the patient. The patient’s symptoms are noted, along with the medical history and family history of the patient.

The doctor then advises the following tests to confirm the diagnosis of multiple myeloma.

  • Blood tests: Multiple myeloma can be diagnosed by routine blood tests that will show M proteins and some abnormal globulins that are produced by myeloma cells. It can also show increased levels of calcium in the blood and very few red blood cells (anemia).
  • Bone marrow aspiration and biopsy: The doctor removes a sample of the bone marrow by inserting a long needle into the bone. This sample is then sent to the laboratory for investigation, where the bone marrow cells are observed under a microscope to assess the abnormalities and types of myeloma cells. 
  • Imaging tests: X-rays, MRI scans, CT scans, and PET scans are imaging tests that help see accurate pictures of bones.
  • Urine tests: Urine testing is needed to confirm the presence of M protein, which is known as Bence Jones proteins when detected in the urine.

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What are the treatments for Multiple Myeloma?

In the early stages of multiple myeloma, no treatment is required. However, the doctor will regularly monitor the patient to check if the disease is progressing.

If the disease starts spreading, and one starts developing signs and symptoms associated with multiple myeloma, the doctor can start with treatment. The following are the different types of treatments that can be done for multiple myeloma:

  • Chemotherapy:
    • Chemotherapy is a treatment that involves anti-cancer drugs that are given according to the stage of the disease. 
    • These drugs kill the cancer cells, which include the fast-growing myeloma cells.
    • Chemotherapy drugs are given in high doses before a bone marrow transplant.

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  • Radiation therapy:
    • Radiation therapy involves the killing of the cancer cells at a specific location using high-energy X-rays or protons.
    • It helps in preventing the build-up of abnormal proteins.
  • Targeted therapy:
    • This form of drug treatment focuses on specific weaknesses that may be present in the cancer cells.
    • Targeted drug therapy helps in blocking these abnormalities leading to the death of the cancer cells.
  • Immunotherapy:
    • This type of treatment boosts the body’s immune (disease-fighting) system to fight the cancer cells.
  • Corticosteroids:
    • Corticosteroids are medications used to regulate the immune system of the body, by controlling the inflammation in the body.
    • These drugs are active against myeloma cells.
  • Plasmapheresis:
    • Plasmapheresis includes using a machine to replace abnormal plasma cells present in blood with normal plasma from donors.
  • Bone marrow transplant or stem cell transplant:
    • Stem cell transplant or bone marrow transplant is the most effective method for treating multiple myeloma. 
    • Bone marrow transplant is a procedure of replacing the diseased bone marrow with healthy bone marrow.
    • Blood-forming stem cells are first collected from the blood, before a bone marrow transplant.
    • High doses of chemotherapy drugs are then given to the patient to destroy the diseased bone marrow.
    • Stem cells are then infused into the body. 
    • These stem cells travel to the bones and begin rebuilding the bone marrow.

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What are the complications of Multiple Myeloma and how are they treated?

The various complications of multiple myeloma and their treatments are:

  • Bone pain: Pain medications, surgery, and radiation therapy can help to control bone pain.
  • Bone loss: Bone-building medications may be recommended by the doctor to prevent bone loss.
  • Infections: Certain vaccinations are recommended by the doctor to prevent infections like pneumonia and flu.
  • Anemia: The doctor may prescribe certain medications for increasing the red blood cell count in the body.
  • Kidney disorders: The doctor may recommend dialysis in cases of severe kidney damage.

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How to care after Multiple Myeloma Treatment?

  • After a bone marrow transplant, the patient is monitored by a doctor for signs of graft rejection. A medication for graft versus host disease is given to prevent this from happening.
  • Antifungals, antivirals, and antibiotic medications are given after a bone marrow transplant to prevent all types of infections.
  • Routine blood tests are performed to check if the blood count has returned to normal and to check the functioning of the donor’s stem cells in the recipient.
  • In case of excessive blood loss or slow recovery, the patient may need a blood transfusion.

What are the risks of Multiple Myeloma Treatment?

The treatment of multiple myeloma may have the following risks based on the type of treatment done:

  • Bone marrow transplant:
    • Graft versus host disease – Donor cells begin to attack recipient cells and therefore cause immune problems.
    • Graft rejection – Donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells.
    • Thrombocytopenia and anemia
    • Infection 
    • Bleeding
    • Damage to the liver
    • Delayed development in children
    • Clotting in blood vessels

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  • Chemotherapy:
    • Hair loss
    • Diarrhea
    • Constipation
    • Skin rashes
    • Infertility
    • Dizziness
    • Fatigue
    • Anemia (decrease in the number of red blood cells)
    • Loss of appetite
    • Increase in risk of infections
    • Neuropathy (damage to the nerves)

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  • Corticosteroids:
    • Indigestion
    • Heartburn
    • Mood changes
    • High blood sugar
    • Increase in appetite
    • Weight gain
    • Insomnia (problems in sleeping)
  • Immunotherapy:
    • Drowsiness
    • Fatigue
    • Constipation
    • Neuropathy
    • Low platelet count
    • Low white blood cell count
    • Anemia (low red blood cell count)
    • Blood clot formation
  • Targeted therapy:
    • Nausea
    • Gastrointestinal problems
    • Nerve damage 
    • Numbness

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  • Radiation therapy:
    • Skin changes
    • Nausea
    • Fatigue
    • Low red blood cells count
    • Diarrhea

How to prevent Multiple Myeloma?

There is no absolute way to prevent multiple myeloma. However, the following tips can help in reducing the risk of developing multiple myeloma:

  • Maintain your weight
  • Eat a healthy diet
  • Exercise regularly
  • Avoid unnecessary exposure to radiation
  • Wear protection of your occupation involves exposure to chemicals and irritants

What is the cost of Multiple Myeloma treatment in India?

The total cost of multiple myeloma treatment in India can range from around INR 8,00,000 to INR 10,00,000. However, the cost of the procedure may vary across different hospitals. There are many big hospitals and specialized doctors in India for multiple myeloma treatment. The cost varies across different hospitals. 

If you are coming from abroad, in addition to the expenses of multiple myeloma treatment, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the procedure, the patient is kept in hospital for 5 days and in the hotel for 15 days for recovery. So, the total cost of multiple myeloma in India will come to be around INR 10,50,000 to INR 13,00,000. 

We hope that we could answer all your questions regarding multiple myeloma through this article.

If you need more information about multiple myeloma and its treatment, you can contact the Surgical Oncologist.

We only aim to give you information through the article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice and correct treatment plan. 

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