Myeloma, also known as multiple myeloma, is a cancer that develops from plasma cells – a type of white blood cell made in the bone marrow. Plasma cells form part of your immune system. Normal, healthy plasma cells produce antibodies called immunoglobulins, that help the body fight infection. In myeloma, these plasma cells become deformed and multiply uncontrollably, releasing only one type of antibody – known as paraprotein – which has no useful function. Unlike many other cancers, myeloma does not form a lump or tumour.
Most medical problems associated with myeloma are caused by large build-ups of abnormal plasma cells in the bone marrow and the presence of the paraprotein in the blood or urine. Myeloma affects multiple places in the body (hence ‘multiple’ myeloma) where bone marrow is normally active in an adult i.e. within the spine, skull, rib cage, pelvis and long bones of the arms as well as the legs, shoulders and hips.
SYMPTOMS OF MYELOMA
- Experience bone pain and/or skeletal fractures. Bone pain is the most common, early symptom ofmyeloma. Most patients experience pain in their back or ribs, however this pain can occur in any bone. The pain is usually constant and is made worse by movement. Myeloma cells secrete a type of chemical called a “cytokine,” which stimulates the cells that dissolve bone (osteoclasts) and inhibits cells that form bone (osteoblasts). In other words, the osteoclasts work overtime, and the osteoblasts are unable to keep up, therefore upsetting the cells’ balance. This leads to holes in the bones, called lytic spots, and osteoporosis (low bone density).
- Fatigue and weakness as a result of low red blood cell counts (anemia). Myeloma patients may get tired more easily and experience feelings of overall weakness. They may also have a pale complexion from anemia (the result of low hemoglobin concentration and/or a low red blood cell count). Anemia is a common medical problem for patients suffering from myeloma, and may contribute to the fatigue.
- Frequent infections due to a weakened immune system. Myeloma patients may experience regular infections because the antibodies needed in order to fight invading viruses, bacteria or other disease agents, are not made efficiently or in adequate numbers. Urinary tract, bronchial, lung, skin or other types of infections are often the first sign of this disease. In addition, recurrent infections may complicate the course of the disease.
- Numbness, tingling, burning or pain in the hands or feet (caused by a condition called “peripheral neuropathy”) are also a common occurrence.
- Some patients develop high levels of calcium, which causes increased thirst and urination, constipation and decreased alertness. In extreme cases these high levels of calcium can cause kidney failure.
- In rare cases, patients can have hyperviscosity syndrome, resulting from high concentrations of M protein in the blood. This causes the blood to thicken. Symptoms of hyperviscosity syndrome include abnormal bleeding, chest pain, headaches, decreased alertness and shortness of breath.
- Some patients can also have amyloidosis, a condition in which the abnormal myeloma protein is deposited in various tissues throughout the body, causing them damage.
TREATMENT OPTIONS AVAILABLE FOR MYELOMA
Killing myeloma cells by way of drug therapy is the mainstay of treatment for myeloma. However, this can cause side effects, especially when chemotherapy is involved. Potent chemotherapy drugs must be toxic enough to kill cancerous cells, but because they also take aim at normal cells, side effects are often the result. Despite this, not everyone experiences side effects and people react differently to overall to this form of treatment. Drug therapy has led to long-term remission in some patients and a temporary remission or significant slowing of the disease in others. As newer, more effective drugs become available, longer remission periods are becoming more frequent. Some patients who have been treated with these drugs may be functionally cured of their disease.
Radiation therapy uses high-energy rays (x-rays) to kill malignant plasma (myeloma) cells and may be used to treat myeloma patients in select circumstances. Those patients whose bone pain does not respond to chemotherapy may also receive radiation therapy. Radiation therapy may be impractical if the bone pain is widely distributed; however there are other means of delivering radiation therapy that are currently under investigation, such as by attaching a radioactive isotope to a molecule that goes predominantly to the bones, where the highest concentration of myeloma is.
STEM CELL TRANSPLANT
A stem cell transplant is a procedure to replace your diseased bone marrow with that of healthy bone marrow. Before a stem cell transplant, blood-forming stem cells are gathered from your blood. You are then given high doses of chemotherapy to destroy the diseased bone marrow you currently have. Finally your stem cells are infused into your body, where they then travel to your bones and begin rebuilding your bone marrow.
Corticosteroids, such as prednisone and dexamethasone, help regulate the immune system to control inflammation in the body. They also are active against myeloma cells. These corticosteroids can be taken in pill form or are administered through a vein in your arm.
- Blood tests: Blood tests that accompany some periodic medical examinations include measuring of the blood proteins, for example albumin. A lab test result showing an elevated level of total protein may lead to further blood and marrow tests and to the diagnosis of myeloma.
- Urine tests: Your doctor will ask you for a urine sample, which they will then send to a laboratory, where a pathologist checks for abnormal antibodies (paraproteins) made by the myeloma cells. One part of the paraprotein is the light chain or Bence Jones protein, which the body disposes of in the urine. Many people with myeloma have Bence Jones protein in their urine. These protein molecules can damage the kidneys as they pass through them from the blood to the urine.
- Bone marrow test: This is referred to as bone marrow aspiration and/or biopsy. It is a test to see if there are any abnormal plasma cells in your bone marrow and if so, how many there are. For this test, the doctor will remove a sample of bone marrow cells (aspirate) to look at under the microscope. They may also remove a sample of bone itself (biopsy).
- X-ray: The large numbers of plasma cells being made in the bone marrow can cause damage to the hard outer casing of the bones. Letting your doctor know which bones are painful will help them to find the damage. Your doctor will ask you to have X-rays of all your long bones as well as your spine, pelvis and skull, to find any areas of damage. This is called a skeletal survey. Your doctor may also ask you to have a chest X-ray to check your general health.