Multiple Myeloma

Multiple myeloma is a cancer of plasma cell, a type of white blood cell which produces antibodies to fight against infection.

In multiple myeloma, overcrowding of cancer cells causes production of abnormal proteins instead of helpful antibodies.These abnormal proteins can cause kidney problems.

Unless you experience signs and symptoms, you may not require treatment. 

You may not experience signs and symptoms of multiple myeloma in the early stage. The signs and symptoms experienced can vary and include:

• Bone pain particularly in your chest or spine
• Nausea
• Constipation
• Loss of appetite
• Lack of mental clarity or mental confusion
• Fatigue
• Recurrent infections
• Reduced body weight
• Weakness or numbness in legs
• Excessive thirst

When to see a Doctor?

If the signs and symptoms you are experiencing worry you, immediately seek medical advice.

The exact cause of multiple myeloma is still unknown.

It is believed that myeloma begins when abnormal plasma cells in bone marrow, the blood cell-producing tissue packed inside your bones, multiply rapidly. This uncontrolled production causes accumulation of cancer cells that produce abnormal antibodies (M proteins). The abnormal antibodies deposit in various parts of your body and lead to different problems such as, kidney damage.  

Multiple myeloma usually begins with a condition called monoclonal gammopathy of undetermined significance (MGUS).

People with MGUS may develop multiple myeloma or related cancer. MGUS and multiple myeloma are characterized by presence of M proteins produced by abnormal plasma cells.

Lower level of proteins and no damage to body are associated with MGUS. 

Making a diagnosis of multiple myeloma is done by performing several tests.

Visit your doctor if you have any signs and symptoms of multiple myeloma. If multiple myeloma is suspected, you may be referred to a hematologist (specialist in treating blood and bone marrow disorder) or oncologist (cancer specialist).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. Here is What you can do.

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• What are the probable causes of my symptoms?
• Do I need to perform any kinds of test?
• What could be the next step in determining my diagnosis and treatment?
• Do you have any specific instruction for the time being?

When you are referred to a specialist, you may ask the following questions:

• Do I have multiple myeloma? If yes, which stage do I have?
• What are the treatment options and possible side effects of each treatment?
• What would be the next step if my treatment is not successful?
• Is stem cell transplant an option for my treatment?
• Do I need medicine to strengthen my bones?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you start experiencing the symptoms?
• Have your symptoms changed overtime?
• Do you have bone pain? If yes, where do you experience the pain?
• Have you had weight loss lately?
• Do you feel nauseated or have reduced hunger?
• Have you been feeling extremely tired recently?
• Have you had recurrent infection such as, pneumonia, sinusitis, bladder or kidney infections, skin infections or shingles?
• Have your bowel habits changed recently?
• Do you have any other medical condition? Have you been treated for any other medical condition?
• Have you been more thirsty or urinated more than usual?
• Are you taking any other medications?
• Do you have a history of blood clots?
• Does your family have history of plasma disorders such as MGUS?

Diagnosis of multiple myeloma includes:

• Blood tests: Blood tests are conducted to detect M proteins and beta-2-microglobulin produced by myeloma cells. These help to determine the aggressiveness of your myeloma. Blood tests can be performed to examine kidney function, blood cell counts, calcium level and uric acid level and help in your diagnosis.
• Urine tests: Urine tests may detect M proteins. M proteins in urine are referred as Bence Jones proteins.
• Examination of bone marrow: A sample of bone marrow may be removed by aspiration (collecting bone marrow sample by inserting long needle into bone). The sample is examined for myeloma cells. Specialized tests such as, fluorescence in situ hybridization (FSH) can be employed to examine the myeloma cells and detect their chromosomal abnormalities. Some tests are done to determine the rate of division of myeloma cells.
• Imaging test: Imaging tests such as, X-ray, MRI, CT scans or positron emission tomography (PET) are performed to detect bone problems associated with multiple myeloma.

If you are diagnosed with multiple myeloma, your doctor from diagnostic tests will stage your disease. Stage 1 is referred to as less aggressive disease whereas stage 3 as aggressive disease that may affect bone, kidneys and other organs. You may be assigned a risk category depending upon the aggressiveness of your disease. Your prognosis and treatment options are dependent on your multiple myeloma stage and risk category.

The goal of treatment for multiple myeloma is to relieve the symptoms, manage the possible complications , stabilize your condition and slow the progression of disease.

You may not be treated if you have smoldering multiple myeloma (myeloma without any symptoms). But you will be regularly monitored to check whether your disease is progressing. If you experience signs and symptoms or show signs of progression of disease, you may require treatment. Since there's no cure for multiple myeloma, treatment is targeted to improve the quality of your life.

• Targeted therapy: This therapy focuses on particular abnormalities of cancer cell without which they can't survive. Targeted drugs such as, bortezomib and carfilzomib are used to block a substance in myeloma cell that breaks down proteins which results in death of myeloma cells. The drugs are given through a vein in your arm.
• Biological therapy: Biological drugs boost immune system and attack myeloma cells. These drugs, taken in pill form, include thalidomide, lenalidomide and pomalidomide.
• Chemotherapy: Chemotherapy drugs are given to kill the fast-growing myeloma cells. The drugs are given through vein or taken in tablet form. Chemotherapy drugs, usually in high doses, are given prior to stem cell transplantation.
• Corticosteroids: Corticosteroids such as, prednisone and dexamethasone, are given to control inflammation by regulation of immune system. They can be taken orally or injected into vein. They are also active against myeloma cells.
• Stem cell transplantation: In this treatment procedure, your diseased bone marrow is replaced by healthy bone marrow. Prior to transplantation, the blood-forming stems cells are collected from your blood and you are given high doses of chemotherapy to destroy the diseased bone marrow. Afterwards, your stem cells are injected back into your body. These cells then travel to bone and start rejuvenating your bone marrow.
• Radiation therapy: Radiation therapy uses ionizing radiations, such as X-rays, to destroy the myeloma cells and retard their growth. Radiation therapy may be used to rapidly shrink the myeloma cells in a certain area where they are causing pain or destroying bone.

The choice and combination of treatments that is likely to be selected for you depend on whether you are a good candidate for stem cell transplantation. This, in turn, depends on your age, overall health and the risk of the disease progression. If you are considered for stem transplantation, your initial treatment will probably comprise a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and at times, chemotherapy. After few months of treatment, your stem cells will be collected and the transplantation process may be started immediately or delayed if relapse occurs. In few cases of multiple, doctor may recommend two stem cell transplants. After stem cell transplantation you may be recommended a maintenance therapy where you will be given targeted or biological therapy to prevent the recurrence of myeloma. If you are not a candidate for stem cell transplantation, your initial therapy will probably comprise a combination of chemotherapy and corticosteroids, targeted therapy or biological therapy. A reduced-intensity stem cell transplant may be chosen for older patients, who are in good health but can't tolerate high dose chemotherapy. In this procedure, lower dose of chemotherapy is used. If myeloma recurs or is unresponsive to treatment, your doctor may suggest repetition of the initial treatment or use other treatments either alone or in combination. You may be qualified for clinical trials where research on new treatment option is ongoing.

Treating Complications

Multiple myeloma is associated with number of complications. Some of them are:

Bone pain: Painkillers, radiation therapy and surgery may help to manage bone pain.

Kidney Complication: Dialysis may be required in people with severely deteriorated kidney function.

Infection: You may be vaccinated to prevent infections such as, flu and pneumonia.

Bone loss: You may be prescribed with bisphosphonates, such as pamidronate or zoledronic acid to prevent bone loss.

Anemia: If you persistently suffer from anemia, you may be prescribed with medications that improve your red blood cell count.

No alternative remedies have been proven to treat multiple myeloma.

However, alternative medicine may be helpful in dealing with the complications of myeloma and side effects of myeloma treatment. Alternative remedies include acupuncture, aromatherapy, massage, meditation and relaxation techniques.

Make sure you consult your doctor before trying these techniques.

Being diagnosed with multiple myeloma can be devastating event. Following tips may be helpful to cope up with the changes:

• Gather sufficient information about multiple myeloma so that you can make appropriate decisions about your treatment and care
• Know, from your doctor, about the treatment options and their side effects
• Join a support group
• Take time for yourself: Eat well, relax and get enough rest to cope up with the stress and fatigue
• Set reasonable goals that can make you focused and in control

There are several risks and complications associated with multiple myeloma.

Risks

• Age: Risk of multiple myeloma increases with age.
• Sex: Male are more like to develop the myeloma than women.
• Race: Blacks are twice as prone as white to develop the disease.
• History of monoclonal gammopathy of undetermined significance (MGUS): People with MGUS are at risk of developing multiple myeloma.

Complications

• Recurrent infection: Multiple myeloma affects the immune system and hence the ability to fight infections.
• Bone problems: Bone pain, thinning of bones and broken bones are associated with multiple myeloma.
• Decreased kidney function: Multiple myeloma may cause kidney damage and kidney failure. Higher calcium level in blood due to erosion of bone can hamper the kidneys' capacity to filter blood wastes. The proteins produced from myeloma cell can also cause kidney damage.
• Anemia: Since normal blood cell production is reduced in myeloma, anemia and other blood problems are frequently seen.