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Multiple Myeloma
Multiple Myeloma is a type of cancer of the Bone Marrow in which myeloma cells multiply abnormally and start to replace the normal plasma cells. This adversely affects the body’s ability to produce antibodies, provide immunity and also weakens the bones. The tumour formed by these malignant plasma cells is called Plasmacytoma and the condition in which many such tumours are developed is known as Multiple Myeloma.
The signs and symptoms of Multiple Myeloma start to appear at a later stage and include-
- Fatigue and Weakness
- Pain in the bones (especially back and ribs)
- Weight loss
- Excessive thirst
- Frequent urination
- Recurrent infections, Fever
- Nausea and Constipation
- Frequent fractures
- Lumps seen underneath the skin (Extramedullary Plasmocytoma)
Multiple Myeloma can be diagnosed by regular Blood Tests which will show M proteins and some abnormal globulins that are produced by the Myeloma cells. It may also show an increased level of Calcium in the blood and very few Red Blood Cells (Anaemia). Bone Marrow Aspiration and Biopsy are essential to confirm Multiple Myeloma. Cells of the bone marrow are observed under the microscope to assess abnormalities and the type of Myeloma cells. MRI scan, CT scan and other imaging tests are helpful to see detailed pictures of the bones. Urine tests are also required in order to confirm the type of proteins produced and to assess its effect on the kidney.
Multiple Myeloma can be treated in the following ways:
- Chemotherapy is the treatment involving anticancer drugs which have to be taken according to the stage of the disease. This has side effects on the body such as – Hair loss, Diarrhoea, or sometimes infertility.
- Radiation Therapy involves killing of cancer cells in a specific location using high energy X-Rays and obstructs the formation of abnormal proteins.
- Plasmapheresis is the replacement of abnormal plasma cells present in the blood with normal plasma from donors, with the help of a machine.
- Stem Cell Transplant / Bone Marrow Transplant is the most effective way to treat Multiple Myeloma. Stem cells of the patient or a donor multiply to form healthy blood cells.
A Bone Marrow Transplant entails the following risks:
- Graft-versus-Host disease - donor cells start to attack those of the recipient and hence causes immunity problems
- Graft rejection - donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells.
- Thrombocytopenia and anaemia
- Infections and Bleeding
- Damage to the liver
- Delayed growth in children
- Clotting- in blood vessels
In case of a bone marrow transplant, the patient is monitored by the doctor for signs of graft rejection. A medication for GVHD is given to prevent it from occurring. Antifungals, antivirals and antibiotics are also given in order to prevent all sorts of infections. Regular blood tests are conducted in order to check if blood counts are back to normal and to check the functioning of the donor’s stem cells in the recipient. The patient may require blood transfusions in case of too much blood loss or slow recovery.
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Multiple Myeloma
Multiple Myeloma is a type of cancer of the Bone Marrow in which myeloma cells multiply abnormally and start to replace the normal plasma cells. This adversely affects the body’s ability to produce antibodies, provide immunity and also weakens the bones. The tumour formed by these malignant plasma cells is called Plasmacytoma and the condition in which many such tumours are developed is known as Multiple Myeloma.
Symptoms
The signs and symptoms of Multiple Myeloma start to appear at a later stage and include-
- Fatigue and Weakness
- Pain in the bones (especially back and ribs)
- Weight loss
- Excessive thirst
- Frequent urination
- Recurrent infections, Fever
- Nausea and Constipation
- Frequent fractures
- Lumps seen underneath the skin (Extramedullary Plasmocytoma)
Diagnosis
Multiple Myeloma can be diagnosed by regular Blood Tests which will show M proteins and some abnormal globulins that are produced by the Myeloma cells. It may also show an increased level of Calcium in the blood and very few Red Blood Cells (Anaemia). Bone Marrow Aspiration and Biopsy are essential to confirm Multiple Myeloma. Cells of the bone marrow are observed under the microscope to assess abnormalities and the type of Myeloma cells. MRI scan, CT scan and other imaging tests are helpful to see detailed pictures of the bones. Urine tests are also required in order to confirm the type of proteins produced and to assess its effect on the kidney.
Treatment
Multiple Myeloma can be treated in the following ways:
- Chemotherapy is the treatment involving anticancer drugs which have to be taken according to the stage of the disease. This has side effects on the body such as – Hair loss, Diarrhoea, or sometimes infertility.
- Radiation Therapy involves killing of cancer cells in a specific location using high energy X-Rays and obstructs the formation of abnormal proteins.
- Plasmapheresis is the replacement of abnormal plasma cells present in the blood with normal plasma from donors, with the help of a machine.
- Stem Cell Transplant / Bone Marrow Transplant is the most effective way to treat Multiple Myeloma. Stem cells of the patient or a donor multiply to form healthy blood cells.
Risks
A Bone Marrow Transplant entails the following risks:
- Graft-versus-Host disease - donor cells start to attack those of the recipient and hence causes immunity problems
- Graft rejection - donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells.
- Thrombocytopenia and anaemia
- Infections and Bleeding
- Damage to the liver
- Delayed growth in children
- Clotting- in blood vessels
After Procedure
In case of a bone marrow transplant, the patient is monitored by the doctor for signs of graft rejection. A medication for GVHD is given to prevent it from occurring. Antifungals, antivirals and antibiotics are also given in order to prevent all sorts of infections. Regular blood tests are conducted in order to check if blood counts are back to normal and to check the functioning of the donor’s stem cells in the recipient. The patient may require blood transfusions in case of too much blood loss or slow recovery.
FAQ Section
In multiple myeloma, a type of white blood cell called a plasma cell multiplies out of control. Normally, they make antibodies that fight infections, but in multiple myeloma, release too much protein called immunoglobulin into your bones and blood, and the builds up throughout your body of this protein causes organ damage.
The plasma cells also crowd normal blood cells in your bones, releasing chemicals that trigger other cells to dissolve bone, weakening the areas of bone, creating regions called lytic lesions.
As multiple myeloma gets worse, those plasma cells begin to spill out of your bone marrow and
spread through your body, which causes more organ damage.
While leukemia is cancer of the blood cells usually which starts in bone marrow and travels through the bloodstream, multiple myeloma is cancer that develops in the bone marrow and affects antibodies producing plasma cells. In myeloma, when plasma cells become cancerous, they may accumulate in the marrow and damage or weaken bone, causing pain. In leukemia, the bone marrow produces mutated cells and spreads them into the blood, where they grow, crowding out healthy blood cells.
The cancer is treatable, but not curable. The most common multiple myeloma treatment has typically been chemotherapy succeeded by stem cell transplants. As the illness is not curable, this method of treatment aimed to create longer and longer extents of time during which it did not progress. Now, however, notable advances in research have dramatically improved not only the prognosis but the treatment that is offered. In fact, treatments have advanced so much that there is an increasing debate among the scientific community as to whether a stem cell transplant should be performed after diagnosis or if it is better to delay the transplant until a relapse.
Scientists are currently experimenting with different combinations of medications to improve the survival rate, and efforts are being made to combine certain drugs that not only have diminished side effects but that also lengthen stretches of progression-free survival of the diseases.
The most common signs of multiple myeloma include:
- Bone problems. The disease can prevent your body from making new bone cells, causing problems like bone pain, weakened bones, and broken bones.
- Fatigue. Healthy cells allow your body to fight invading germs easily, but as myeloma cells replace bone marrow, your body has to work much harder with fewer disease-fighting cells, and because of which you tire more easily.
- Kidney problems. Myeloma cells produce harmful proteins that can cause kidney damage and even cause failure.
- Low blood counts. Myeloma cells crowd out healthy blood cells, leading to low red blood counts and low white blood cells.
- Frequent infections. Fewer antibodies in your blood make fighting infections more challenging for your body.
Other common symptoms of multiple myeloma include:
- Nausea
- Constipation
- Loss of appetite
- Weight loss
- Weakness or loss of feeling in your legs
- Swelling in your legs
- Increased thirst
- Frequent urination
- Confusion
- Dizziness
- Pain, especially in your back or belly
Yes, Multiple Myeloma is a fatal disease, but due to the recent advancement, the survival rate of patients with myeloma has improved a lot.
The most common cause of death related to myeloma is the infection, with pneumonia being the most common fatal infection. Other common causes of death are bleeding (from low platelet counts), kidney failure, complications of bone fractures, and blood clots in the lungs.
The final stage of myeloma is marked by the presence of many cancer cells in the body.
Characteristic of this stage include:
Anemia
Hypercalcemia
Advanced bone damage (3 or more bone lesions)
High levels of M protein in the blood or urine
Treatments for myeloma options include:
- Targeted therapy: Targeted drug treatment focuses on specific abnormalities within cancer cells that enable them to survive. They do this by blocking the action of a substance in myeloma cells that breaks down proteins, which causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in form of pills.
- Biological therapy: Biological therapy drugs use your body's immune system to fight cancer cells. Commonly taken in pill form, these medications enhance the immune system cells that identify and attack cancer cells.
- Chemotherapy: Chemotherapy drugs kill fast-growing cells, including myeloma cells.
- Corticosteroids: Corticosteroids regulate the immune system to control inflammation in the body. They are also active against myeloma cells and can be taken in pill form or administered through a vein in your arm.
- Bone marrow transplant: A bone marrow transplant, also known as a stem cell transplant, is a procedure to works by replacing your diseased bone marrow with healthy bone marrow.
- Radiation therapy: This treatment uses beams of energy to damage myeloma cells and stop their growth.
Myeloma is currently considered treatable and not curable. This is because we don't have any treatment method that could prevent Myeloma from returning.
Multiple myeloma 5-year survival rate is 50% but some patients beat the odds and live 10 to 20 years or more.
Since multiple myeloma makes the immune system weaker, the patient needs to steer clear of any foods that could make him or her sick, including:
- Raw meat or fish
- Runny eggs
- Unpasteurized drinks
- Sushi
- Unwashed fruits and vegetables
The cost of treatment depends on the stage of cancer, and the estimated cost of Multiple Myeloma Treatment in India is INR 8 Lakh to 10 Lakh.