Stepwise Diagnosis of Multiple Myeloma - A Complete Guide

Introduction

White blood cells, called plasma cells, are responsible for producing antibodies. This is where multiple myeloma, a type of cancer, begins to grow. As they accumulate in the bone marrow, these atypical plasma cells impair the body's defenses and interfere with the regular synthesis of blood cells. Diagnosis of multiple myeloma takes various processes but usually a bone marrow biopsy is used.

What Is Multiple Myeloma?

A particular type of white blood cell, known as a plasma cell, is the reason behind multiple myeloma. Normally, these cells produce antibodies that aid the body in fighting infections. In multiple myeloma, these cells proliferate uncontrollably and concentrate in the bone marrow. This can occur due to various factors because it disrupts the normal process by which the body produces red blood cells. Some features of myeloma include:

• Multiple myeloma first affects the bone marrow, the spongy tissues found in the cavities of the bones. The abnormal plasma cell production is crowded in the bone marrow, which affects the formation of RBC (red blood cells), WBC (white blood cells), and platelets.

• Abnormal plasma cells produce a protein called M-protein or monoclonal; its presence is used as a diagnostic tool for myeloma-affected people.

• It also damages the bones and causes bone lesions.

• The monoclonal proteins also impair the kidney in the advanced stages. Other complications include anemia (low RBC), hypercalcemia (elevated calcium level), and infections.

What Are the Causes of Multiple Myeloma?

The exact causes of multiple myeloma remain mostly unclear; however, various risk factors have been identified by studies as potential contributors to the development of this hematologic malignancy. Multiple myeloma is a complex disease with likely multifactorial origins.

• Myeloma is generally diagnosed in older individuals, with the majority of cases occurring at the age of 60 and above.

• Individuals with this family history may have a higher risk of developing this disease by themselves.

• Certain racial and ethnic groups, particularly Africans and Americans, have an increased chance of having this disease.

• Multiple myeloma is a little more common in men than in women. The causes of this gender disparity are not entirely understood.

• Radiation explosions are also a factor in the development of this disease.

• Other plasma cell disorders, such as single cysts of plasma cells, M- protein or monoclonal gammopathy of undetermined significance (MGUS), and smoldering myeloma, affect the plasma cells and develop into multiple myeloma.

• Obesity.

What Are the Symptoms of Multiple Myeloma?

• Bone Pain: It is produced particularly in the rib cage, hips, lower back, or middle back.

• Broken Bones: Myeloma cells cause harm to the surrounding bone. The likelihood of the weaker bone breaking is higher.

• Fatigue: Reduced RBC production due to myeloma causes shortness of breath.

• High Calcium Level: The body's elevated calcium level is the cause of confusion.

• Swelling of the Leg: Multiple myeloma affects the kidney, which is responsible for eliminating extra fluids and salt in the blood, causing swelling.

• Lack of WBCs: Certain infections are due to low production of white blood cells in the bone marrow.

• Impaired Bowel Movements: Feeling sick to the stomach or having trouble with regular bowel movements.

• Weight Loss: Unexplained weight loss. Changes in urination and feeling very thirsty due to kidney issues.

What Is the Stepwise Diagnosis of Multiple Myeloma?

A. Blood Test:

M-proteins can be found in the blood by a test called serum protein electrophoresis (SPEP). These are the abnormal proteins that plasma cells with malignancy make. Blood calcium levels can be measured using additional tests.

B. Urine Test:

A doctor might ask an individual to collect urine over 24 hours, and they will use a urine protein electrophoresis (UPEP) test to find proteins. These are not normal proteins; they are produced by cancerous plasma cells.

C. Bone Marrow Aspiration and Biopsy:

In most patients, myeloma is located in the bone marrow. Physicians suggest a biopsy of the bone marrow by using a long needle to take out a small sample of the bone marrow for laboratory examination. Looking at the bone marrow under a microscope helps the doctor check for cancerous cells and understand their aggressiveness. This information is crucial for prognosis and planning the right treatment.

D. Tumor Biopsy:

Tumors called plasmacytomas can form in the surrounding soft tissues or the bone in cases of multiple myeloma. To look for cancer cells, these tumors may be surgically removed or subjected to a biopsy before being examined under a microscope.

E. Diagnosis of Bone Marrow:

Cytology, histology, and cytogenetic analysis (chromosome analysis and FISH) to identify adverse cytogenetic abnormalities.

F. Imaging Studies:

Multiple myeloma-related bone lesions or fractures may be seen on X-rays. This is crucial, in particular, for determining bone involvement. CT (computerized tomography) scans give full cross-sectional photocopies of the body, enabling the assessment of disease severity, the identification of abnormalities in the bones, and the determination of whether or not organs are involved.

G. Genetic and Molecular Testing:

Identifying specific chromosomal abnormalities through fluorescence in situ hybridization (FISH) is one genetic testing technique to detect multiple myeloma. It facilitates making decisions about prognosis, prediction, and therapy.

What Are the Treatment Methods for Multiple Myeloma?

• Medical treatment like chemotherapy which targets and damages cancer cells. For better results in treating multiple myeloma, different medications, such as Bortezomib, Lenalidomide, and Dexamethasone, are frequently combined.

• Immunomodulatory drugs such as Lenalidomide and Thalidomide boost the body's immune response against cancer cells.

• Proteasome inhibitors disrupt protein breakdown, causing the accumulation of proteins and leading to cell death in myeloma cells.

• Autologous stem cell transplantation involves using the patient's stem cells after high-dose chemotherapy to rebuild the bone marrow and is often considered for eligible individuals, especially those under 65.

• Targeted therapies like Daratumumab and Elotuzumab focus on specific molecules that hinder the growth and survival of myeloma cells.

• Corticosteroids, like Dexamethasone, are used alongside other treatments to control inflammation and enhance chemotherapy's effectiveness.

• To target particular myeloma-affected bone areas and reduce pain and fracture risks, radiation therapy can be used.

Conclusion

Oncologists find it challenging and must be careful when diagnosing and treating the disease. Fortunately, people with this complex condition have improved because of improved ways to find the problem and better medicines. Ongoing research that keeps discovering more about multiple myeloma gives hope that even better treatments will be available.