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Multiple Myeloma

multiple myeloma

In this article, you’ll get everything you need to know about Multiple Myeloma.

Overview

Multiple Myeloma (MM) is a cancer of the plasma cells, a type of cells found in the bone marrow. They play a significant role in our immune system, along with lymphocytes B and T. Together, they fight infections and several other diseases. In MM, plasma cells grow out of control and produce a specific compound called M-protein. Other conditions may also present with dysfunctional plasma cells, but they do not meet all the criteria for cancer. Diseases with abnormal plasma cells are monoclonal gammopathy of uncertain significance (MGUS), smoldering multiple myeloma (SMM), solitary plasmacytoma, and light chain amyloidosis.

How common is multiple myeloma?

MM is generally rare. However, it is the second most frequent type of blood cancer, following non-Hodgkin lymphoma, in the US. An estimated 32,110 people suffered from MM in the US in 2019. Also, about 12,960 adults died because of MM the past year. The five-year survival rate for individuals with MM is over 50%. In the case of an early diagnosis, it reaches 72%. When there is metastasis, the five-year survival rate is a little bit less than 50%.

What are the risk factors for multiple myeloma?

Risk factors raise your likelihood of presenting with a disease in the future. Some people may develop MM without having any significant risk factors. Similarly, having some risk factors doesn’t mean you will present with cancer. However, it is essential to know all of them and make efforts to avoid them, even though none of them is well-established. The following are the most well-known and widely-accepted risk factors for MM:

  • Being over sixty years old. The average diagnosis of MM is seventy years old.
  • Race. MM is more common in black people than in white people.
  • Exposure to radiation. Those that exposed themselves to iatrogenic or non-iatrogenic radiation have a higher risk of developing MM.
  • Exposure to chemicals. Exposure to chemicals such as asbestos, benzene, or pesticides may increase your chance of presenting with MM.
  • Gender. Men are a little bit more prone to develop MM than women.
  • Personal history. Solitary plasmacytoma of bone significantly raises your risk for MM.
  • MGUS. MGUS raises a person’s chance to develop MM by 1% to 2%.

What causes multiple myeloma?

Scientists don’t know what exactly causes MM. However, they know where it starts from and what the consequences are if left untreated. Blood cancer cells are not able to mature. They die and accumulate in the bone marrow, suppressing the well-being of healthy cells. Eventually, plasma cells crowd out healthy cells, making it harder for the immune system to fight infections efficiently. However, myeloma cells continue producing abnormal antibodies, which may cause bone and kidney problems or other issues in the body, due to their accumulation. Usually, MM starts as a benign condition known as MGUS. The hallmark of the disease is the M-protein, which signifies the presence of myeloma cells.

Symptoms and signs of multiple myeloma

Symptoms and signs of MM are not always specific. Early stages of the disease might present without any symptoms at all. If present, symptomatology of MM includes some of the following:

  • Bone pain, especially in the core of the body
  • Nausea or vomiting
  • Loss of appetite
  • Constipation
  • Weak immune system with frequent infections
  • Mental confusion
  • Unexplained weight loss
  • Weakness in the limbs
  • Sensory disturbances, such as numbness of the legs
  • Feeling thirsty all the time

Symptoms are not always indicative of MM. Therefore, it is usually challenging to make a diagnosis. As a result, early identification of MM is rare. Some people start visiting a doctor after a pathological fracture.

Diagnosis of multiple myeloma

MM is a disease that doctors might accidentally identify when looking at some blood test results. Further analysis may reveal the M-protein, produced by the myeloma cells. Beta-2-microglobulin is another abnormal protein that a doctor may identify through blood analysis. It is essential to check also the kidney function parameters, along with your uric acid and calcium levels. Urinalysis is also necessary to reveal the M-protein or any kidney disturbances. Bone marrow aspiration and biopsy is a specialized investigation when doctors already suspect a bone marrow cancer. After obtaining the sample, scientists check it for myeloma cells. Finally, imaging tests are necessary to find out whether metastasis took place or not.

Treatment of multiple myeloma

MM usually requires disease-directed treatment using drug therapies. Chemotherapy, targeted therapy, and immunotherapy are the principal and most effective interventions. A combination of them with stem cell transplantation may be needed. The treatment plan goes as follows:

  • Induction therapy
  • Consolidation
  • Maintenance therapy

Radiation therapy and surgery are not first-line options but may be necessary to relieve symptoms. Some people with early-stage MM may need active surveillance during which a patient does frequent check-ups to monitor the disease. Other drug therapies used in combination or alone are steroids.

Bone-modifying drugs strengthen bones and lower the risk of fractures in people with MM. The maximum amount of time a person can be on bone-modifying drugs is two years. Keep in mind that drug therapies might have side effects. For example, bisphosphonates, a class of bone-modifying medication, may lead to flu-like symptoms, kidney problems, and bone or muscle pain. A quite rare but potential side effect of these drugs is osteonecrosis of the jaw. Talk with your doctor about the possible side effects of each therapeutic intervention and get the necessary tests before you start on any treatment.

References
https://www.cancer.net/cancer-types/multiple-myeloma/introduction
https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html

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