Myeloma

Myeloma, also known as multiple myeloma, is a type of blood cancer that originates in plasma cells, a type of white blood cell found in the bone marrow. Plasma cells are responsible for producing antibodies that help the body fight infections. In multiple myeloma, cancerous plasma cells multiply uncontrollably, producing abnormal proteins, impairing bone marrow function, and causing damage to bones and other organs.

Types of Myeloma

Multiple Myeloma: The most common type, where multiple areas of bone marrow are affected.
Plasmacytoma: A single area of plasma cell tumour, which can be isolated to a bone (solitary bone plasmacytoma) or soft tissue (extramedullary plasmacytoma).
Smoldering Myeloma: An early or asymptomatic form of multiple myeloma, where there are abnormal plasma cells, but the patient may not yet experience symptoms.

Causes and Risk Factors

The exact cause of myeloma is unknown, but certain risk factors have been identified:
- Age: Most commonly occurs in people over 60.
- Gender: Men are slightly more likely to develop myeloma than women.
- Race: African Americans have a higher incidence of multiple myeloma compared to other racial groups.
- Family history: Having a close relative with multiple myeloma increases the risk.
- Pre-existing plasma cell disorders: Conditions like monoclonal gammopathy of undetermined significance (MGUS) increase the risk of developing myeloma.

Symptoms of Myeloma

Myeloma symptoms can vary widely but are often summarized using the acronym CRAB, which stands for:

C – Calcium elevation (hypercalcemia): High levels of calcium in the blood can cause symptoms like nausea, vomiting, constipation, excessive thirst, confusion, and weakness.
R – Renal (kidney) dysfunction: The abnormal proteins produced by myeloma cells can damage the kidneys, leading to kidney failure.
A – Anemia: Due to the impaired function of the bone marrow, fewer red blood cells are produced, causing fatigue, weakness, and shortness of breath.
B – Bone damage: Myeloma cells often collect in bones, leading to bone pain, fractures, and osteoporosis.
Other symptoms may include:

Frequent infections due to impaired immune function.
Weight loss.
Numbness or weakness in the legs (if the spinal cord is compressed).
Increased bruising or bleeding.

Diagnosis

Multiple myeloma is diagnosed using a combination of tests:

Blood tests:
- Complete Blood Count (CBC): To check for anemia and low blood cell counts.
- Serum protein electrophoresis: Detects abnormal monoclonal proteins (M proteins) produced by myeloma cells.
- Beta-2 microglobulin: A marker of disease severity.
Urine tests:
- Bence Jones protein: Abnormal proteins excreted in the urine, indicative of myeloma.
Bone marrow biopsy: To confirm the presence of cancerous plasma cells in the bone marrow.
Imaging studies: X-rays, CT scans, MRI, or PET scans to detect bone lesions or fractures caused by myeloma.
Cytogenetic tests: To identify specific genetic abnormalities in myeloma cells, which can influence prognosis and treatment options.

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Stages of Multiple Myeloma

Multiple myeloma is staged based on the Revised International Staging System (R-ISS), which considers factors such as blood levels of beta-2 microglobulin, albumin, and other markers. The stages are:

Stage I: Early disease with lower levels of abnormal cells and less organ damage.
Stage II: Intermediate disease.
Stage III: Advanced disease with higher levels of abnormal cells and significant organ damage.

Complications

Myeloma can lead to several complications, including:

Kidney failure: Due to high levels of abnormal proteins and calcium.
Bone fractures: Due to bone weakening or osteoporosis.
Infections: Due to impaired immune function.
Anemia: Resulting from bone marrow suppression.
Hypercalcemia: Elevated calcium levels can cause neurological symptoms and affect the heart and kidneys.

Treatment of Myeloma

The treatment of multiple myeloma depends on the stage of the disease, the patient’s overall health, and the presence of symptoms. Treatment options may include:

Chemotherapy: Often used to kill rapidly dividing cancerous plasma cells.
Targeted Therapy: Drugs like proteasome inhibitors (e.g., bortezomib, carfilzomib) and immunomodulatory drugs (e.g., lenalidomide, thalidomide) target specific aspects of myeloma cells.
Immunotherapy:
- Monoclonal antibodies (e.g., daratumumab) target specific proteins on the surface of myeloma cells to help the immune system destroy them.
- CAR T-cell therapy: A newer treatment where T-cells are genetically modified to attack myeloma cells.
Steroids: Medications like dexamethasone or prednisone are often used to help kill myeloma cells and reduce inflammation.
Stem Cell Transplant (Bone Marrow Transplant): This involves high-dose chemotherapy followed by a transplant of the patient’s own stem cells (autologous stem cell transplant) to rebuild healthy bone marrow.
Radiation Therapy: Used to treat areas of bone affected by myeloma or to relieve pain.

For smoldering myeloma or early-stage disease without symptoms, doctors may recommend “watchful waiting” or close monitoring before starting treatment.

Prognosis

The prognosis for multiple myeloma varies depending on the stage at diagnosis, the patient’s overall health, and how well they respond to treatment. While multiple myeloma is generally considered a chronic condition that is difficult to cure, many treatments can extend survival and improve quality of life. Some patients may live many years with the disease, especially with newer therapies and improved supportive care.

Advances in treatment, especially with targeted therapies and stem cell transplants, have significantly improved outcomes for many patients with multiple myeloma. However, relapse is common, and treatment plans are often adjusted over time to manage the disease.