Introduction:
A type of cancer affecting the plasma cell, a type of white blood cell, is called multiple myeloma. Plasma cells originate in the bone marrow, the soft tissue that forms the center of hollow bones. Apart from plasma cells, the bone marrow also produces other healthy blood cells. Therefore, treatment is not usually necessary if the patient has no signs or symptoms. And for symptomatic patients, various treatment options are available to control the disease.
Is There a Difference Between Multiple Myeloma, Lymphoma, and Leukemia?
Multiple myeloma, lymphoma, and leukemia are cancers affecting the blood cells but affect different body parts.
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Lymphoma begins and affects the lymphatic system.
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Leukemia arises in the bone marrow and affects the blood and bone marrow.
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Multiple myeloma affects the plasma cells, a type of white blood cell.
What Are the Common Types of Multiple Myeloma?
There are two main subtypes of multiple myeloma:
Hyperdiploid (HMM) - The abnormal plasma cells have more chromosomes than normal. Almost 45 % of cases are of this type and are generally less aggressive.
Non-Hyperdiploid or Hypodiploid - The abnormal plasma cells have fewer chromosomes than usual. It is more aggressive, and 40 % of the cases are of type.
The other common kinds of multiple myeloma and precancerous conditions that can result in multiple myeloma are:
Light Chain Myeloma - This is when the myeloma cells make incomplete immunoglobulins (antibodies) called light chain antibodies. 20 % of patients have this type.
Non-secretory Myeloma - Patients do not make enough light chain antibodies to get detected in any test.
Solitary Plasmacytoma - The plasma cells become cancerous and grow abnormally, resulting in plasmacytoma, a tumor that usually affects the bone.
Monoclonal Gammopathy of Undetermined Significance (MGUS) - This condition results in the body producing an abnormal protein or M protein, which can be found in the blood and urine. 1 in 5 MGUS patients develops multiple myeloma.
Smoldering Multiple Myeloma (SMM) - It is a precancerous condition, and this condition does not result in symptoms. As these patients have more M proteins in the blood or more myeloma plasma cells in the bone marrow, they are more likely to get the active kind of myeloma.
Immunoglobulin E (IgE) Myeloma - This is the rarest form of multiple myeloma. It is aggressive and progresses rapidly to plasma cell leukemia.
Immunoglobulin D (IgD) Myeloma - This is a rare condition, and men younger than 60 years are most susceptible.
What Are the Common Signs and Symptoms of Multiple Myeloma?
Most patients do not have any signs or symptoms during the early stages of this condition. However, as cancer progresses, symptoms appear, which vary from one person to another. The common symptoms include:
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Tiredness.
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Bone pain and weakness.
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Bone fractures easily.
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Kidney disease or failure.
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Anemia (low red blood cells).
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Frequent infections.
How Does Multiple Myeloma Affect the Body?
In multiple myeloma, abnormal plasma cells multiply and accumulate in the bone marrow. This outnumbers the bone marrow's healthy blood cells, leading to anemia, tiredness, and other multiple myeloma symptoms. And instead of producing antibodies that fight off infection, cancer cells produce abnormal antibodies, monoclonal proteins, or M proteins. These proteins build up in the patient’s body, which damages the kidneys.
What Are the Risk Factors of Multiple Myeloma?
Some of the common factors that can increase the risk of a person developing multiple myeloma are:
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People who are 60 years and older.
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African-Americans are more likely to develop this than Caucasians.
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Men are susceptible.
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Family history of the condition.
How Is Multiple Myeloma Diagnosed?
Sometimes, multiple myeloma is accidentally diagnosed during a routine blood test, or if the doctor suspects that a patient might have multiple myeloma, the following tests are performed.
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Blood Tests - To detect M proteins in the blood. And to detect how aggressive the condition is, the beta-2-microglobulin level in the blood is checked. In addition, the total blood count, kidney function test, calcium, and uric acid levels are also tested.
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Urinalysis - Bence Jones proteins, that is, M proteins in the urine, are detected.
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Bone Marrow Examination - A sample of the bone marrow is collected and tested. The sample is examined for myeloma cells using fluorescence in situ hybridization (FISH). It also gives an idea of how fast the cancer cells are multiplying.
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Imaging - An X-ray, MRI, or CT scan is done to check for bone problems.
What Are the Stages of Multiple Myeloma?
The disease is assessed when the physician diagnoses multiple myeloma, and staging is essential to manage the condition accordingly. The three stages are classified based on the disease activity.
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Stage 1: Less aggressive multiple myeloma.
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Stage 2: Intermediate.
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Stage 3: Most aggressive type.
How Is Multiple Myeloma Treated?
Treatment helps relieve pain, prevent complications, and slows the progression of the disease in patients with symptoms. However, if there are no symptoms, treatment is usually unnecessary, and the doctor monitors the condition regularly. The treatment options for multiple myeloma include:
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Targeted Drug Treatment - (Bortezomib, Carfilzomib, Ixazomib) - These drugs attack and block the action of a specific substance in the cancer cells and break down the protein.
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Biological Therapy - (Thalidomide, Lenalidomide, Pomalidomide) - These drugs enhance the immune system and fight off cancer cells.
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Chemotherapy - Chemotherapy drugs kill cells that multiply and grow fast, including myeloma cells.
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Corticosteroids - (Prednisone, Dexamethasone) - These drugs control inflammation by regulating the immune system.
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Bone Marrow Transplant - A stem cell transplant is done to replace the diseased bone marrow.
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Radiation Therapy - X-rays and protons are used to destroy myeloma cells.
Treatment For Complications:
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Painkillers - To reduce pain and discomfort.
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Dialysis - In case of kidney failure.
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Vaccinations - To prevent infections.
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Bisphosphonates (Pamidronate, Zoledronic acid) - To prevent bone loss.
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Iron Tablets - To treat anemia.
What Are the Possible Complications of Multiple Myeloma?
The possible complications include:
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Frequent infections.
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Anemia.
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Bone fractures.
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Possible kidney failure.
Conclusion:
Multiple myeloma is treatable but not curable. Some patients have to alter their lifestyles to cope with the pain and other symptoms of multiple myeloma. If symptoms worsen, consult a doctor. It is a slow-progressing disease and can be controlled by starting treatment. In addition, a physician’s supervision is necessary to monitor the progression of the disease.