Oncology

Exploring Multiple Myeloma: Signs, Origins, Evaluation

admin Jun 19, 2024

Introduction

Multiple myeloma, also known as Kahler's disease, is an uncommon type of blood cancer. It develops in the plasma cells of the bone marrow (the soft part inside the bone) and occurs in people over 60 years of age. There's no cure, but proper treatment can slow the spread and reduce the symptoms.

Healthy plasma cells fight infections by producing antibodies that attack germs. In multiple myeloma, cancerous plasma cells multiply in the bone marrow, where red blood cells are made. Instead of producing antibodies, they make a protein (called immunoglobulin) that doesn’t fight infection and spreads in the body, causing harm to bones and kidneys.

Multiple Myeloma Symptoms

The symptoms don’t appear in the early stages, making multiple myeloma diagnosis difficult initially. Hence keeping a close watch may be essential. However, if they appear, the symptoms may include:

Bone pain and fractures

a-Pain in bones- A mild or acute pain, depending on the severity of the condition is experienced in the middle and/or lower back, rib cage, skull, or hips.

b-Pathological fractures – Multiple myeloma triggers bone destruction. The weak bones may lead to pathological fractures.

Nervous system-related symptoms

a-Spinal cord damage- Since myeloma causes spinal cord damage, it may result in bowel incontinence and weakness in the lower limbs.

b-Numbness of limbs- Nerve compressions and hyperviscosity (thickening of the blood), lead to numbness in the face and limbs and may cause confusion.

Kidney-related symptoms

a-Kidney damage- Immunoglobulin protein deposition and increased calcium levels in the blood can damage the kidneys, causing altered mental states, constipation, breathlessness, fatigue, and swelling in the legs.

b-High calcium levels can cause extreme thirst, dehydration, abdominal pain, decreased appetite, weight loss, and nausea.

Blood count-related symptoms

a-Anemia- Low hemoglobin manifests as fatigue and/ or shortness of breath with exertion. Patients have trouble walking, climbing stairs, and doing the daily chores.

b- Compromised Immunity-Reduced WBC can make patients more vulnerable to infections like pneumonia, bladder or kidney infections, sinusitis, and skin infections.

Leukemia symptoms can be confused with that of multiple myeloma as both affect the bones. However, leukemia also manifests as bleeding, bruising, and nosebleeds.

How is multiple myeloma diagnosed?

Multiple myeloma diagnosis includes-

1-Blood and urine tests to check immunoglobulin levels.

2-Imaging tests- X-ray, MRI scan, CT scan, or PET scan to show bone problems linked with the disease.

3-Biomarker testing of the tumor to identify specific chromosomes and genes.

4-Bone marrow biopsy.

Multiple Myeloma Treatments

In the absence of symptoms, the doctor may prefer to monitor the patient closely rather than start bone cancer treatment immediately. In the case of symptoms, the treatment which is similar to leukemia treatment may consist of:

Targeted therapy- This therapy uses medicines that attack certain chemicals in the cancer cells by blocking them and causing the cancer cells to die.
Immunotherapy- It is a treatment that involves using the body’s immune system to kill cancer cells using medicines.
CAR-T cell therapy- Chimeric antigen receptor T cell therapy, also called CAR-T cell therapy, involves treating the immune system cells externally with special receptors. These are then given back to the body to destroy the multiple myeloma cells.
Chemotherapy- The therapy uses strong medicines based on the age of the patient and the severity of the condition to kill any fast-growing cancer cells.
Corticosteroids- These medicines help control inflammation (swelling and irritation) in the body and act against myeloma cells.
Stem cell transplant. Also known as the bone marrow transplant, the procedure replaces affected bone marrow with a healthy one.
Bisphosphonates- Bisphosphonates are a class of drugs that prevent the loss of bone density.
Radiation therapy-Radiation therapy uses powerful energy beams to kill cancer cells.
Surgery- Surgical intervention may be required to contain bone pain.
Dialysis- Dialysis may be necessary in case of kidney damage.
Vaccines- Vaccines may be used to treat flu and pneumonia due to low immunity in multiple myeloma.

Since the symptoms don’t appear in the early stages making multiple myeloma diagnosis difficult initially. The key is to discuss all the bone marrow cancer treatment options, their goals, and side-effects with the doctor and make an informed decision that best suits the patient.