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A Guide to Multiple Myeloma
Multiple myeloma or also known as Kahler’s disease is a type of bone marrow cancer. The survival rate of multiple myeloma based on the study between 2010 and 2016 is 54%. So, what is myeloma?
The simple definition of multiple myeloma is cancer formed by white blood cells called plasma cells. Plasma cells in the human body make antibodies that fight infections in the body. When an individual has multiple myeloma, these cells multiply the wrong way. They let too much immunoglobulin into the bones and blood that will cause build-up throughout the body and damage different body organs.
This type of cancer doesn’t have any cure, but it helps to slow down the spread of cancer through different treatments. In some instances, the treatments for multiple myeloma is not always necessary right away, some myeloma is slow-growing and does not show any sign and symptoms. In cases like this, doctors may recommend close monitoring before proceeding to any treatments.
Types of Plasma Cell Disorders
Aside from multiple myeloma, many other conditions can cause problems with the plasma cells, including:
- Monoclonal Gammopathy – It is when plasma cells multiply the same antibody. It is commonly found on a blood test when looking for other conditions.
- Solitary Plasmacytoma – This is a type of abnormal plasma cell growth that is cancerous. It often develops in a bone and is usually treated with radiation therapy.
- Waldenstrom Macroglobulinemia – this disorder is similar to multiple myeloma and non-Hodgkin lymphoma. Multiple myeloma is a cancer of plasma cells, while non-Hodgkin lymphoma is a cancer of lymphocytes. The Waldenstrom macroglobulinemia cells feature both of them.
Risk Factors and Causes of Multiple Myeloma
Few risk factors increase a person’s chance of getting a disease, such as cancer. Having these risk factors doesn’t mean that the person will immediately get the disease, or someone without this will not get the disease. These are just things that might increase the chance of it. Here are a few risk factors that might affect an individual’s chance of getting multiple myeloma:
- Family History
- Experiencing other plasma cell diseases
Multiple Myeloma Symptoms
Patients with myeloma experience different symptoms, but some patients have no symptoms at all in rare cases. Here are some common symptoms of myeloma:
- Bone pain in any part of the body but most often in the back, hips, and skull
- Bone weakness such as osteoporosis or Plasmacytoma
- Fractured bone from minor stress or injury
Low Blood Count
The shortage of red blood cells, white blood cells, and blood platelets are usual in multiple myeloma and might lead to other symptoms such as:
- Anemia – fewer counts of red blood cells can cause weakness, shortness of breath, reduced ability to exercise, and dizziness.
- Leukopenia – reduced number of white blood cells that can lower resistance to infections like pneumonia.
- Thrombocytopenia – too few blood platelet counts; this may cause severe bleeding even with minor scrapes, cuts, or bruises.
High Blood Levels of Calcium
High levels of calcium can make a patient slip into a coma. It can also cause the following:
- Extreme thirst
- Kidney problems that may lead to kidney failure
- Severe constipation
- Abdominal pain
- Loss of appetite
Nervous System Symptoms
Spinal cord compression happens when the myeloma weakens the bones in the spine until it collapses and presses on spinal nerves. The compression may cause sudden extreme back pain, numbness on the legs, and muscle weakness.
Myeloma protein can also damage the kidneys. A blood test or urine test will help determine the damages to the kidney. When the kidney starts to fail, it loses the ability to eliminate excess salt, fluid, and body waste products. Failure of the kidney will lead to symptoms such as:
- Shortness of breath
- Leg swelling
Tests to Find Multiple Myeloma Cancer
If symptoms show that an individual might have multiple myeloma, the doctor will refer them to different tests to confirm it.
- Blood Counts: A Complete Blood Count (CBC) is a test used to measure red cells, white cells, and platelets in the blood.
- Blood Chemistry Tests: A blood test to measure lactic dehydrogenase levels (LDH) can be an indicator of a patient’s prognosis. High levels mean that the disease is more advanced and may have a worse prognosis.
- Urine Tests: A urine sample will help to look for myeloma protein filtered through the kidney. This test is called UPEP or Urine Protein Electrophoresis and urine immunofixation.
- Quantitative Immunoglobulins: In a patient with multiple myeloma, the level of immunoglobulins in one type may be high while the others are low. To test this, doctors use quantitative immunoglobulins to measure any abnormally high or low immunoglobulins.
- Electrophoresis: Serum protein electrophoresis (SPEP) measures the antibodies in the blood and can find a monoclonal antibody produced by myeloma cells.
- Serum-free light chains: This blood test will help to measure the light chain levels in the blood of the patient. It is the test that will assist in looking for myeloma or light chain amyloidosis.
Bone Marrow Biopsy
Individuals with multiple myeloma have a lot of plasma cells in their bone marrow. The test that the doctors use to check the bone marrow is called bone marrow biopsy and aspiration. In this procedure, the pelvic bone is numbed by anesthesia. Then, a needle will be inserted into the bone, and a syringe is used to get a small amount of liquid bone marrow. The sample will be sent to other tests to seek out any signs of multiple myeloma.
Imaging tests are used to create photos of the inside of the body. It is done for many reasons such as:
- Looking for suspicious areas that might have cancer
- Checking how much cancer has spread
- Determining if the treatment is working
- Bone X-ray
- CT Scan
- MRI Scan
- Positron emission tomography
Diagnosis of Multiple Myeloma
Once the myeloma cancer has been tested, diagnosis of multiple myeloma requires either:
- A plasma cell tumor or a minimum of 10% plasma cells are present in the bone marrow.
- At least one of the following:
- High blood calcium level
- Poor kidney function
- Low red blood cell counts
- Holes in the bones from a tumor found on imaging tests
- Increase in one type of light chain in the blood
- 60% or more of the plasma cells are in the bone marrow
This term is used when the myeloma is found early and not causing any symptoms. Individuals with smoldering myeloma have signs such as their plasma cells in the bone marrow between 10% and 60%. They have a high level of monoclonal immunoglobulin in the blood and a high level of light chains in the urine. However, they usually have normal blood counts, calcium levels, kidney function, and no bone or organ damage.
Light Chain Amyloidosis
Diagnosing light chain amyloidosis is when the patient has all of the following:
- Signs and symptoms of light chain amyloidosis
- Biopsy result that shows amyloid in any tissue
- A positive test that shows that the amyloid protein is a light chain and not a heavy one
- The abnormal plasma cells are present in the bone marrow, high levels of monoclonal immunoglobulin in the blood or the urine.
Treatment and Medications for Multiple Myeloma Patients
There are different treatments and medications that the doctor will consider if the patient has multiple myeloma. Treatments for this cancer will not cure it, but they will definitely help to slow down the progress of cancer spreading and lessen the symptoms to make the patient’s life better.
The drug that the patient will take will depend on the age and how threatening the cancer is.
- Chemotherapy – Doctors usually give chemotherapy drugs in mixtures. Some drugs that treat multiple myeloma are bendamustine, cyclophosphamide, doxorubicin, etoposide, liposomal doxorubicin, melphalan, and vincristine.
- Corticosteroids – These drugs are used to help other treatments work better. When the patient is doing chemo, the doctor might prescribe this to help with the side effects.
- Targeted therapies – Medications like these target proteins, genes, or tissues. Targeted therapies will prevent cancer from growing, and it includes:
- Immunomodulatory drugs
- Monoclonal antibodies
- Proteasome inhibitors
- Histone deacetylase inhibitors (HDAC)
- Nuclear export inhibitor
- Antibody Drug Conjugates
- Interferon – This is taken with patients who had treatment and under remission. Interferon is released by the bone marrow cells and some white blood cells, and if it is used as a drug, it may slow the growth of myeloma cells.
Stem Cell Transplant
Stem Cell Transplantation is one of the primary treatments that the doctors will suggest once diagnosed with multiple myeloma. It will help the patient live longer but doesn’t cure cancer. It might also cause extremely serious complications.
The procedure of stem cell transplant is made at the hospital. They will use a machine to remove some of the patient’s stem cells or use stem cells from a donor, and then they will freeze and store them. Once this is done, the patient will receive high-dose chemotherapy with a combination of radiation therapy. The chemo and radiation will help destroy most of the cells in the bone marrow, both plasma cells that cause cancer and the healthy ones.
The doctor will then insert a tube called a catheter to put the saved or donated stem cells into the bloodstream. These will replace the destroyed bone marrow and eventually start making healthy blood.
Aside from the medications and stem cell transplant, treatment for the bone will also be considered, especially if the multiple myeloma of the patient causes painful bone damage, and this includes:
- Bisphosphonates – A drug that helps slow down bone breakdown. The drug can be administered through medicines as a pill or inject directly into the patient.
- Monoclonal Antibodies – This medication can pause or even stop the cells that are breaking down in the patient’s bone.
- Radiation Therapy – The radiation beam will kill cancer cells once the doctor directs it to the affected bone. It will ease the pain and make weakened bones stronger.
Multiple Myeloma Prognosis and Outlook
A doctor can’t know the exact course of cancer because the experiences of patients who had multiple myeloma will vary. Few might live for years with symptoms, while others might have worse conditions immediately. However, they can give a prognosis to the patients through the results of the tests, rate of tumor growth, and the patient’s age, fitness, and medical history.
In current times, the treatment for myeloma is constantly improving. However, the treatment can’t cure the disease yet. Still, it will be a big help since it can manage the symptoms and improve patients’ quality of life. Once the myeloma is under control, patients normally return to a good health state that might last for several months to years before further treatment is needed.
Start Taking Care of Yourself
Multiple myeloma cancer can be hard for you once diagnosed. Leading a healthy life to reduce the risk of this cancer is a must. Now that you have read this article, you can reach out to All American Hospice for medical advice, and we will help you with this battle. We promise to deliver the medical care that you deserve to make you more comfortable.