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Multiple Myeloma - Types, Symptoms, Risk Factors, Treatments, and Complications

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Multiple Myeloma - Types, Symptoms, Risk Factors, Treatments, and Complications

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Multiple myeloma is a plasma cell cancer. This article includes its types, signs, symptoms, risk factors, treatment, and complications.

Medically reviewed by

Dr. K. Shanmuganandan

Published At December 9, 2019
Reviewed AtDecember 29, 2023

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.

  • Lymphoma begins and affects the lymphatic system.

  • Leukemia arises in the bone marrow and affects the blood and bone marrow.

  • 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:

  • Tiredness.

  • Bone pain and weakness.

  • Bone fractures easily.

  • Kidney disease or failure.

  • Anemia (low red blood cells).

  • Leukopenia (low white blood cells).

  • 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:

  • People who are 60 years and older.

  • African-Americans are more likely to develop this than Caucasians.

  • Men are susceptible.

  • 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.

  • 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.

  • Urinalysis - Bence Jones proteins, that is, M proteins in the urine, are detected.

  • 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.

  • 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.

  • Stage 1: Less aggressive multiple myeloma.

  • Stage 2: Intermediate.

  • 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:

  • 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.

  • Biological Therapy - (Thalidomide, Lenalidomide, Pomalidomide) - These drugs enhance the immune system and fight off cancer cells.

  • Chemotherapy - Chemotherapy drugs kill cells that multiply and grow fast, including myeloma cells.

  • Corticosteroids - (Prednisone, Dexamethasone) - These drugs control inflammation by regulating the immune system.

  • Bone Marrow Transplant - A stem cell transplant is done to replace the diseased bone marrow.

  • Radiation Therapy - X-rays and protons are used to destroy myeloma cells.

Treatment For Complications:

  • Painkillers - To reduce pain and discomfort.

  • Dialysis - In case of kidney failure.

  • Vaccinations - To prevent infections.

  • Bisphosphonates (Pamidronate, Zoledronic acid) - To prevent bone loss.

  • Iron Tablets - To treat anemia.

What Are the Possible Complications of Multiple Myeloma?

The possible complications include:

  • Frequent infections.

  • Anemia.

  • Bone fractures.

  • 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.

Frequently Asked Questions

1.

How Does Multiple Myeloma Occur?

Multiple myeloma is a cancer of the plasma cells (type of white blood cell) of the bone marrow. Like every other cancer, these cells become abnormal and cancerous on their own due to genetic mutations and begin to multiply at a faster rate than the healthy plasma cells. They accumulate within the bone marrow outnumbering healthy cells.

2.

What Are the Early Warning Signs and Symptoms of Multiple Myeloma?

Multiple myeloma does not show any early signs or symptoms. Symptoms over time include,
- Excessive thirst.
- Bone pain (frequently in the spine, skull, and long bones).
- Infections.
- Constipation.
- Fatigue.
- Appetite loss.
- Unintentional weight loss.
- Leg and arm weakness.
- Numbness.
- Hypercalcemia.
- Nerve damage.
- Skin lesions.

3.

Where Does Multiple Myeloma Initially Occur?

Multiple myeloma starts from within the bone in the bone marrow’s plasma cells. They replicate and accumulate within the bone marrow. Over time they spread to other parts of the body through the harmful antibodies (M protein) that these abnormal plasma cells release.

4.

What Are the Stages of Multiple Myeloma?

The newer revised international staging system (RISS) stages multiple myeloma into three stages based on the albumin, beta-2 microglobulin (B2M), and lactate dehydrogenase (LDH) levels, and genetic changes.
Stage 1- Albumin, B2M, and LDH levels are normal and genetic changes are not aggressive.
Stage 2- Albumin is low, B2M is normal to high.
Stage 3- B2M and LDH levels are high and have highly abnormal genetic changes.

5.

What Happens in the Advanced Stage of Multiple Myeloma?

In the advanced stages, the symptoms get worse. Frequent infections, bone pain, fatigue, fractures, abdominal pain, anemia, sick feeling, etc., are experienced. The life expectancy during this stage is expected to be another three to four years.

6.

Who Is Prone to Get Multiple Myeloma?

- People having a family member with multiple myeloma.
- Males.
- African American race.
- People above 65 years of age.
- Obese or overweight people.
- People with radiation exposure.
- Firefighters.
- People working in rubber factories are exposed to chemicals.
- Farmers exposed to herbicides.

7.

Does Multiple Myeloma Occur Without Any Symptoms?

Multiple myeloma does not exhibit any symptoms in the initial stage. If and when someone experiences any symptom, the disease would be in the advanced stage. Smoldering Myeloma, a type of multiple myeloma, is an asymptomatic and inactive variant.

8.

How Deadly Is Multiple Myeloma?

Though there is no cure for multiple myeloma, prompt identification and treatment of the symptoms caused by myeloma can sustain and improve the quality of life. People under symptomatic management of myelomas were found to live for more than five years. Average survival rates range from three to ten years.

9.

Does Multiple Myeloma Progress Fast?

Multiple myelomas are found to spread through the bloodstream, making it easy and quick for them to spread throughout the body.

10.

When Can Multiple Myeloma Be Suspected?

Multiple myeloma does not cause any symptoms in the early stages. However, abnormally high levels of M protein in the blood and urine tests done for other purposes can raise suspicion for multiple myeloma. It can be suspected in older people above 50 years of age with persistent back pain for more than a month.

11.

Is Multiple Myeloma Highly Aggressive?

The immunoglobulin E and hypodiploid types of multiple myeloma are more aggressive forms of multiple myelomas.

12.

Are Multiple Myeloma and Myeloma the Same?

Multiple myeloma and myeloma are the same. It is just that both terms are used interchangeably.

13.

How Does Living With Multiple Myeloma Feel?

While some multiple myeloma survivors do not have any symptoms and feel alright, some feel fatigued and weak with persistent pain in their back. Numbness, recurrent infections, and itchiness accompany. Generally, they tend to feel sick.

14.

Is Multiple Myeloma Curable?

Multiple myeloma is not curable. Treatments are aimed to ease the symptoms, reduce complications, prolong life, and slow down the disease progression.

15.

Should Multiple Myeloma Be Treated?

Usually, treatment is not advised if there are no prevailing symptoms. Careful monitoring of the health condition will be done. Upon the presence of symptoms, symptomatic treatment is recommended. If the symptoms are not treated, the disease progression will be fast, and it may lead to complications like anemia, bone loss, infections, kidney failure, back pain, fractures, etc.
Dr. K. Shanmuganandan
Dr. K. Shanmuganandan

Rheumatology

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multiple myeloma
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