Multiple Myeloma: Understanding the not so uncommon cancer

What is myeloma?

Multiple myeloma is a cancer that affects a specific type of white blood cell called plasma cells. These cells are normally responsible for producing antibodies to help fight infections. However, in multiple myeloma, abnormal plasma cells accumulate in the bone marrow, crowding out healthy blood cells and producing abnormal proteins that can cause complications throughout the body.

What are the symptoms?

1. Weakness and numbness: Due to damage to nerves by abnormal proteins produced by myeloma cells, patients may experience weakness, numbness, or tingling, especially in the legs.
2. Fatigue: Patients may experience persistent tiredness or weakness, which can be severe and interfere with daily activities.
3. Frequent infections: Myeloma can suppress the immune system, leading to an increased risk of infections.
4. Bone fractures: The weakened bones in myeloma are prone to fractures, even with minor trauma.
5. Kidney problems: Myeloma proteins can damage the kidneys, leading to symptoms such as increased thirst, decreased urine output, and swelling (edema).
6. Anemia: A decrease in red blood cells can cause symptoms such as weakness, fatigue, and shortness of breath.
7. Weight loss: Unexplained weight loss can occur in some cases of myeloma.
8. Nausea and constipation: These symptoms may occur if myeloma affects the digestive system or due to medications used in treatment.
9. Hypercalcemia: High levels of calcium in the blood, which can cause symptoms like excessive thirst, frequent urination, nausea, vomiting, constipation, and confusion.

It's important to note that some people with myeloma may not experience any symptoms initially, and the disease may only be detected through routine blood tests or imaging done for other reasons. If you suspect you or someone else may have symptoms of myeloma, it's crucial to seek medical evaluation promptly for proper diagnosis and management.

What factors put me at an increased risk of this disease?

Some of the key risk factors include:

1. Age: Multiple Myeloma primarily affects older adults, with the average age at diagnosis being around 65-70 years.
2. Gender: Men are slightly more likely to develop Multiple Myeloma than women.
3. Race: African Americans are at higher risk compared to Caucasians.
4. Family History: Individuals with a family history of multiple myeloma or certain other plasma cell disorders may have an increased risk.
5. Monoclonal Gammopathy of Undetermined Significance (MGUS): MGUS is a precursor condition to multiple myeloma, where abnormal plasma cells are present but do not yet meet the criteria for a cancer diagnosis.

Other potential risk factors include obesity, exposure to certain chemicals or radiation, and possibly some viral infections. However, many cases of Multiple Myeloma occur in individuals without any identifiable risk factors.

What are the few tests done to confirm Multiple Myeloma?

When a patient presents with the symptoms of myeloma, a few tests are done to confirm the same and plan treatment.

1. Blood Tests: These include a complete blood count (CBC) to check for abnormalities in blood cell counts, and serum protein electrophoresis (SPEP) to detect the presence and type of M protein.
2. Urine Tests: Urine protein electrophoresis (UPEP) is often performed to further analyze the presence and quantity of M protein that may be excreted by the kidneys.
3. Bone Marrow Biopsy: A sample of bone marrow is taken from the hip bone or another large bone to examine under a microscope for the presence of myeloma cells.
4. Imaging Studies: X-rays, CT/PET-CT scans, or MRI scans may be used to assess bone damage and detect any fractures or lesions caused by myeloma.

Once a diagnosis is confirmed, additional tests may be done to determine the extent of the disease (staging) and to guide treatment decisions.

What are the treatment options?

The treatment of Multiple Myeloma has evolved significantly in recent years, offering more options and improved outcomes for patients. Treatment plans are individualized based on factors such as the patient's age, overall health, and the stage of the disease. Key treatment modalities include:

1. Chemotherapy: Traditional Chemotherapy drugs are often used to kill cancer cells and reduce the burden of myeloma in the body.
2. Targeted Therapy: Drugs that specifically target myeloma cells or their environment, such as proteasome inhibitors (e.g., bortezomib) and immunomodulatory drugs (e.g., lenalidomide), have become standard in treatment regimens.
3. Stem Cell Transplantation: High-dose chemotherapy followed by a stem cell transplant from the patient (autologous) or a donor (allogeneic) may be recommended for eligible patients to help restore healthy bone marrow function.
4. Immunotherapy: Monoclonal antibodies, such as daratumumab and elotuzumab, have shown promise in targeting and destroying myeloma cells while sparing healthy cells.
5. Supportive Care: Managing symptoms and complications, such as bone pain, infections, and kidney problems, is an important part of comprehensive myeloma care.

What are the recent advances?

Recent research has uncovered new insights into the biology of multiple myeloma and has led to the development of novel treatment strategies. Some of the notable advances include:

1. CAR T-cell Therapy: Chimeric antigen receptor (CAR) T-cell therapy, which involves genetically modifying a patient's T cells to recognize and attack myeloma cells, has shown promising results in clinical trials.
2. Targeting the Bone Marrow Microenvironment: Drugs that target interactions between Myeloma cells and their surrounding bone marrow microenvironment are being explored to disrupt the supportive environment that allows myeloma cells to thrive.
3. Precision Medicine Approaches: Advances in genomic sequencing and molecular profiling are helping to identify specific genetic mutations and biomarkers that can predict how individual patients will respond to certain treatments.
4. Minimal Residual Disease (MRD) Assessment: Improved methods for detecting minimal residual disease (small amounts of cancer cells that may remain after treatment) are helping to assess treatment response and guide decisions about further therapy.

Multiple Myeloma remains a challenging disease, but significant progress has been made in understanding its underlying biology and developing effective treatments. Early diagnosis, personalized treatment plans, and ongoing research into new therapies are key to improving outcomes for patients with this complex condition. By raising awareness and continuing to support research efforts, we can strive towards better management and, ultimately, finding a cure for multiple myeloma.