Multiple Myeloma

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Overview

Multiple myeloma or Kahler’s disease occurs when the plasma cells become cancerous, start dividing abnormally in the bone marrow and eventually form tumours in various bones present in the body.

B lymphocytes (B cells), a type of white blood cell generated in the bone marrow, give rise to plasma cells. When bacteria or viruses infect the body, the B cells transform into plasma cells. These plasma cells start synthesising antibodies, which fight bacteria and viruses and prevent infection and illness.

In India, multiple myeloma is the third most common haematological malignancy after leukaemia and non-Hodgkin’s lymphoma.

Symptoms

The severity of symptoms, the rate of disease progression and other factors vary from patient to patient. In some cases, patients with multiple myeloma show no symptoms. Following are some of the commonly seen symptoms among multiple myeloma patients:

Moderate to severe pain in bones (especially in the regions of lower back and ribs)
Frequent bone fractures
Spinal cord compression
Hypercalcemia or high levels of calcium
Frequent infections
Unexpected weight loss
Easy bruising and bleeding caused due to low platelet count
Breathing difficulties
Anaemia
Extreme tiredness and fatigue
Weakness in the legs and arms

A good number of these symptoms are associated with other health conditions as well; therefore, it is important to visit a physician for a conclusive diagnosis.

Courses

The exact cause of multiple myeloma is unknown. However, a few risk factors for multiple myeloma have been identified:

History of Monoclonal Gammopathy of Undetermined Significance (MGUS): In most cases, multiple myeloma starts as MGUS, which is a benign condition wherein an abnormal protein called the M protein is present in the blood.
Family History of Multiple Myeloma: Having a family history of multiple myeloma increases one’s risk of developing this condition.
Age: The risk of getting multiple myeloma increases with age. In most cases, people diagnosed with multiple myeloma are in their mid-60s.
Gender: Multiple myeloma is found to be more common in men than women.
Obesity: Studies have found that those with obesity are at a higher risk of developing multiple myeloma.
Ethnicity: This condition is found to be more prevalent among people of African and African-American ethnicity.

Diagnosis

Multiple diagnostic methods are available to detect and diagnose multiple myeloma. Our specialists at HCG provide superior diagnostic support to patients with multiple myeloma and ensure that they receive the right treatment, the first time.

a. Physical Examination and Medical History Assessment: Initially, when an individual presents themselves with symptoms, the doctor recommends a physical exam and medical history assessment to understand the possible causes of the symptoms. If he/she suspects multiple myeloma, additional tests will be recommended.

b. Lab Tests: Lab tests help in determining the levels of specific proteins. In the case of multiple myeloma, the doctor may recommend lab tests, which include blood tests and urine tests to check for beta-2-microglobulin and M protein, which are found in patients with multiple myeloma. Hypercalcemia is another indicator of multiple myeloma; therefore, the doctor may also recommend tests to check the calcium levels.

Additionally, lab tests may also be recommended to examine critical factors like kidney function, blood cell counts and uric acid levels.

c. Bone Marrow Biopsy: During bone marrow biopsy, a long needle is inserted into a bone to collect a small amount of bone marrow tissue. This tissue is later examined for the presence of abnormal plasma cells or myeloma cells.

Additionally, the bone marrow sample may be subjected to additional tests, such as flow cytometry, immunohistochemistry, cytogenetics and fluorescent in situ hybridisation (FISH), which help in obtaining clearer insights with respect to the presence of special proteins, chromosome abnormalities, etc.

d. Imaging Tests: Imaging tests, such as bone X-ray, MRI scans, PET scans and CT scans, are recommended to study the extent of the disease. These tests are extremely helpful in checking if cancer has spread to other parts of the body if the given treatment is working and also in checking if the disease has come back

Treatment

There are various treatment options available for multiple myeloma. Timely diagnosis and appropriate treatment plans support the successful management of multiple myeloma. Following are the main treatment options available for multiple myeloma:

a. Close Monitoring: In some cases, multiple myeloma does not cause any serious symptoms, and the patient would be doing just fine; this condition is referred to as smouldering multiple myeloma. In such cases, the doctor may recommend ‘close monitoring’ wherein regular blood and urine tests are conducted to study the disease progression. The treatment is recommended only when the disease starts showing symptoms.

b. Chemotherapy: Chemotherapy is one of the standard treatment options available for multiple myeloma. This treatment approach involves the usage of powerful anticancer drugs, which, when injected, destroy the myeloma cells present throughout the body.

c. Targeted Therapy: Targeted therapy is a form of precision medicine that involves the usage of specific drugs that identify and attack myeloma cells only. Targeted therapy minimises damage to the healthy tissues and has a huge role in reducing the risk of treatment-related side effects in multiple myeloma patients.

d. Immunotherapy: In cancer patients, the disease-fighting ability of the body is compromised as cancer cells produce specific substances that keep them hidden from the immune cells. Immunotherapy works by triggering the patient’s immune system to launch an attack against the myeloma cells. It may involve the usage of specific components produced in the body or the laboratory to boost, guide or restore the body’s immune functions and support the body fight against the disease.

e. Bone Marrow Transplant: Bone marrow transplant involves the replacement of diseased bone marrow cells with healthy ones. Before the transplant, the patient is made to undergo high-dose chemotherapy, which helps in destroying the myeloma cells. Later, the healthy bone marrow, which is received from a donor, is transfused into the patient’s body for the production of healthy bone marrow cells.

f. Corticosteroid Therapy: Corticosteroid therapy involves the administration of steroid medications, which work by stopping the white blood cells from travelling to the regions where myeloma cells are present. Steroid medications help in reducing the inflammation and swelling and the pain and pressure associated with the inflammatory reaction.

g. Radiation Therapy: Radiation therapy is a cancer treatment that involves the use of high-energy x-rays or other forms of radiation to kill or stop cancer cells from growing and spreading. Radiation therapy can also help in alleviating symptoms, such as pain, in cases where the disease has spread to bones.

Frequently Asked Questions

1. Is multiple myeloma treatable?

Yes, multiple myeloma is treatable. Today, there are multiple treatment options available for this condition.

However, it is important for this condition to be diagnosed in the early stages. Timely diagnosis is necessary to achieve good clinical outcomes. It is important for one to be aware of the symptoms associated with multiple myeloma and consult a doctor if these symptoms are witnessed.

2. Does obesity cause multiple myeloma?

Yes. Obesity is one of the risk factors for multiple myeloma. Those who are obese have an increased risk of developing multiple myeloma.

However, losing excess weight is found to bring down the risk of this condition.

3. What are the possible treatment-related complications associated with multiple myeloma?

The treatment response varies from patient to patient. Some patients may experience milder complications, while some may experience moderate to severe complications. However, we can manage these complications if they are reported on time.

Commonly experienced complications include bone pain, infections, anaemia, bone loss and kidney complications.

4. Can multiple myeloma come back?

Yes. Even after successful treatment, there are chances of multiple myeloma coming back. However, if they are detected early, they can be managed.

It is important for patients with multiple myeloma to strictly adhere to the follow-up regimen given by the expert team after the treatment. These follow-up visits can help the doctors in detecting relapses in the early stages when they can be treated with better outcomes.

5. Can I prevent multiple myeloma?

There are no known ways to prevent multiple myeloma entirely, as it is associated with the factors that cannot be controlled, such as gender, age, ethnicity, family history, etc.

Nevertheless, obesity is also a risk factor for this condition, and therefore, maintaining a healthy weight and having a healthier lifestyle may help in reducing the risk of this condition. You may also consider regular screening if you are identified as a high-risk individual.