Multiple myeloma- Causes, Treatments

What is Multiple myeloma? 

Multiple myeloma is a particular type of blood cancer that arises from the plasma cells in the bone marrow. Myeloma is frequently referred to as multiple myeloma since 90% of patients with the disease have multiple bone lesions.

The immune system is primarily composed of white blood cells called normal plasma cells. They are found in the spongy bone marrow. They aid in fighting infection and are a component of the immune system. When malignant, these abnormal plasma cells proliferate throughout the bone marrow, leaving no space to produce enough regular blood cells.

Bone marrow is present in body parts like the spine, skull, shoulders, ribs and pelvis.

Other names for this blood cancer are

• Multiple Myeloma
• Kahler disease
• Myelomatosis and
• Plasma cell myeloma

Plasma cells produce antibodies that destroy the viruses and bacteria when the body is fighting against an infection. A plasma cell multiplies quickly if it develops cancer. This is referred to as multiple myeloma. The healthy blood cells are replaced with cancerous cells in this condition. Instead of producing antibodies, the cancerous cells produce abnormal proteins, which result in complications.

Causes of Multiple myeloma 

Myeloma starts when abnormal plasma cells, or myeloma cells, accumulate in the bone marrow and develop tumours in the bones.

These tumours, known as plasmacytomas, may stop the bone marrow from producing sufficient healthy blood cells. Multiple myeloma is the term used for the condition when there are two or more tumours. 

Myeloma doesn’t have a known aetiology. Myeloma risk has been associated with exposure to certain chemicals, viruses like HIV and high levels of radiation (For example: from working in a nuclear power plant).

The disease is not thought to be inherited; therefore, it is unlikely for more than one member of a particular family to have myeloma. 

Symptoms of Multiple myeloma 

Fracture 

The bone around the tumour is destroyed by myeloma cells. Weaker areas in bones are prone to breaking. This is referred to as a pathological fracture.

Bone pain, particularly in the hips, ribs or lower back, is noticeable. Depending on the stage of the multiple myeloma, the rate at which it has progressed and whether a fracture or nerve compression has taken place, the pain may be minimal or severe.

Weakness 

Anaemia caused by myeloma can result in excessive fatigue or shortness of breath due to overexertion. Nerve compressions that can cause numbness in the limbs are occasionally linked to multiple myeloma. The face, arms or legs may become weakened or numb as a result of hyperviscosity.

Frequent infection 

There is a chance of infection because myeloma cells prevent healthy white blood cells from circulating, which fight infection. Pneumonia, kidney or bladder infections, sinusitis and skin infections are typical illnesses associated with myeloma.

Leg swelling

Kidney damage from multiple myeloma prevents them from functioning properly. This indicates that the body can’t eliminate excess fluids and salts, which might result in swelling.

Confusion 

Kidney failure and excessive blood calcium levels are two complications of multiple myeloma. Confusion may result from this. Blood that is too thick or hyperviscous can also cause confusion. 

Changes in appetite 

Reduced appetite, weight loss and nausea can also be brought on by kidney disease or high blood calcium levels. This also induces excessive thirst.

Risk Factors for Multiple myeloma 

Some factors may raise the chance of myeloma development, such as the following.

Age 

Most myeloma patients are over 50 years old. Myeloma is less common in adults under the age of 40.

Obesity 

According to research, myeloma is more common in obese people.

Sex 

Myeloma affects men more frequently than women.

Medical history 

People with a history of MGUS (Monoclonal gammopathy of undetermined significance) in their medical history are prone to multiple myeloma.

Environment 

Some studies are looking into whether radiation or exposure to specific chemicals, like pesticides, fertilisers and Agent Orange, may play a role in developing myeloma.

Presence of inflammatory symptoms or disorders (Example: cardiovascular disease or type II Diabetes).

Occupation 

According to several research, firefighters are significantly more likely than the general population to get several types of cancers.

Diagnosing Multiple myeloma 

Blood tests 

CBC (Complete Blood Count)

This blood test can detect anaemia, low platelet count (thrombocytopenia) and low red blood cell count.

Chemical tests

Laboratory blood test analyses include total protein, albumin, calcium, immunoglobulins and creatinine, which, together with other tests, can help determine prognosis. Creatinine is a measure of renal function. Immunoglobulin and total protein might be elevated in myeloma.

Immunoglobulins

The heavy chains (IgG, IgA, IgM, IgD, and IgE) can be quantified and followed serially to evaluate a patient’s reaction to treatment.

Serum Protein Electrophoresis (SPEP)

The SPEP is a blood test that measures all plasma proteins and can spot an abnormal elevation (spike) in myeloma patients.

Immunofixation or Immunoelectrophoresis (IEP, IF, IFE)

This blood test can be used to determine the specific malignant heavy chain and light chain present (for example, IgG kappa or IgA lambda).

Beta 2 microglobulin

Together with albumin, this blood test is particularly helpful for outcome prediction during diagnosis.

Imaging tests 

Bone surveys and X-rays

Bone x-rays have traditionally been used to detect fractures and lytic lesions. Even though it would be time-consuming, a bone survey of all bones could reveal asymptomatic involvement and aid in myeloma diagnosis. 

Plain X-rays are quite insensitive and have been replaced by other tests in the evaluation of myeloma, while they are still useful for specific diagnoses.

MRI Scan

Myeloma and imminent fractures can both be diagnosed using the highly sensitive imaging technique known as magnetic resonance imaging (MRI), which uses magnets. Currently, we can perform whole-body MRIs for myeloma on a restricted basis.

Tomography using positron emission (PET)

PET scanning is a nuclear medicine procedure that detects plasma cell cancers in any bone in the body by employing trace amounts of radioactively-labelled sugar. It is incredibly sensitive and quick at spotting reactions and relapses. It also has the benefit of giving a complete view of the body at once.

Bone marrow biopsy 

The rear of the hip (not the spine) is most usually used for bone marrow aspirations and biopsies, and the breastbone is only occasionally used (sternum). Cells from the marrow are examined using a trephine biopsy and bone marrow aspiration. Typically, a local anaesthetic is used. A little sample of bone marrow is taken using a tiny needle and examined under a microscope during the biopsy.

Treatment for Multiple myeloma 

Chemotherapy and other medications, like thalidomide and steroids, are frequently used as part of early treatment.

Steroids 

Corticosteroids, a type of steroid, can be used to reduce oedema and inflammation, modify immune system reactions, and actively destroy myeloma cells. Typically administered as pills, corticosteroids can be used alone or in combination with chemotherapy or other anti-myeloma medications.

Chemotherapy 

Chemotherapy, which is used to treat cancer, can be given orally, intravenously or topically. The aim of chemotherapy is to kill cancer cells.

Radiation therapy 

Some symptoms of multiple myeloma, including bone pain, can be relieved with radiation therapy (also known as radiotherapy), which uses x-rays to destroy or harm cancer cells. 

Stem cell transplant 

In a stem cell transplant, the bone marrow is first destroyed by a high dosage of chemotherapy, which is followed by the transplantation of blood-forming stem cells to save the bone marrow and increase the number of blood cells. This method of treatment that is carried out in stages. The entire process might take months to complete, and not everyone is eligible for the treatment.

Typically, the stem cells used in a stem cell transplant are taken from the patient (autologous transplant). Sometimes, another person’s stem cells are utilised (allogeneic transplant).

Medications

• Thalidomide 

Thalidomide works by inhibiting the blood flow to malignant cells and activates the body’s immune system to fight myeloma cells. It is taken in the form of tablets. Lenalidomide, a recent medication that functions similarly, is often prescribed to those with relapsed myeloma.

• Bortezomib

Myeloma may also be treated with bortezomib, a medication that prevents the breakdown of protein in myeloma cells, causing them to stop growing and die.

• Bisphosphonate

Drugs called bisphosphonates are used to lessen bone pain and stop myeloma cells from weakening or damaging bones further. Additionally, they stop risky elevation in blood calcium levels.

Palliative care 

Palliative care is essential and suggested by some medical professionals in some myeloma cases. Palliative care works to enhance the quality of life by easing cancer symptoms.

This treatment can also alleviate pain and aid in managing other symptoms, in addition to decreasing the progression of myeloma. Chemotherapy, radiation and other pharmacological therapies are possible forms of treatment.

Complications of Multiple myeloma 

Multiple myeloma interacts with numerous other body systems and can cause a wide range of problems since it is a blood cancer. Multiple myeloma side effects include

• Anaemia – A deficiency in red blood cells brought on by the healthy bone marrow cells’ displacement by abnormal plasma cells.

• Leukopenia – A deficiency in white blood cells that could harm the immune system.

• Bone erosion or lesions – The cytokines that myeloma cells produce can trigger osteoclasts (bone cells) to destroy the nearby bone. X-rays reveal osteoporosis or dark holes (lytic lesions) in the bone when more than 30% of the bone has been damaged. A bone is more likely to break where it is weak.

• Elevated blood calcium levels – Bone deterioration is associated with high blood calcium levels. The bloodstream receives calcium from the bones, which affects other bodily systems.

• Hyperviscosity – In some circumstances, high levels of m proteins (Myeloma proteins) can thicken the blood and obstruct blood flow into tiny blood vessels.

Preventing Multiple myeloma 

There exists no known method for preventing myeloma development. Certain risk factors that are linked to myeloma can be avoided, though.

Multiple myeloma prognosis 

Since all individual’s circumstances are unique, it is difficult for a doctor to anticipate the precise course of a disease. The type of myeloma one has, the findings of the tests, the rate of tumour growth, as well as the age, level of fitness and medical history, may all be taken into account by a doctor while determining the prognosis or likely the course of the disease.

Although there is currently no cure for myeloma, treatment can help control the condition, manage the symptoms and enhance the quality of life. When the myeloma is in check, people typically resume their previous level of health, which may persist for several months or years before more treatment is required.

Conclusion 

Multiple myeloma is a type of cancer that develops in bone marrow plasma cells. Plasma cells are a component of the immune system.

The bones may develop malignancies as a result of multiple myeloma. They harm and erode the bone.

Some individuals show no symptoms. Depending on the location of the tumour, others may experience symptoms. These symptoms can include dizziness, bone pain, weakness, shortness of breath and frequent urination.

Being over 65, being a man, being overweight and exposure to specific chemicals are risk factors.

Active monitoring, chemotherapy, radiation therapy, targeted therapy and stem cell transplant are all possible forms of treatment for multiple myeloma.

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