Multiple Myeloma - What It Is, Symptoms, Causes & Treatment Options

What is Multiple Myeloma?

Multiple Myeloma, cancer of plasma cells is the second most common blood cancer around the world. Plasma cells are a type of white blood cells, which produce antibodies that protect the body from infection. They are found in the bone marrow, which is the spongy tissue seen in some bones.

In multiple myeloma, the plasma cells clone and proliferate excessively, displacing healthy bone marrow cells that produce red blood cells, platelets, and other types of white blood cells (WBC). This sets off a chain reaction of illnesses and disorders that can harm multiple organs like bones, kidneys, and the body's capacity to produce healthy red, white, and platelet blood cells.  Multiple organ systems are affected, hence the name.

What Does One Experience?

It mainly affects adults in the age group of 65-70 years. Multiple myeloma presents with different kinds of symptoms which can resemble a lot of other conditions. Initially one may not experience any symptoms. This cancer does not cause any lump or tumour.

Some may not experience any symptoms and the condition may be accidental when blood or urine tests show abnormally high protein. This type is called smouldering myeloma.

Rarely, cancer cells concentrate in a particular bone or soft tissue, rather than involving many organs. This is called solitary myeloma/plasmacytoma.

The are many symptoms one can experience:

1. Bone pain and fracture –
   1. The bone-producing cells get destroyed. Additionally, bone-degrading cells increase. So this causes soft spots in the bone and can fracture easily.
   2. Any bone can be affected, but commonly  involves the back, the hips, and the skull.
2. Hypercalcaemia – Due to bone destruction, calcium levels in the blood increase. This leads to destroyed
   1. Abdominal pain
   2. Constipation
   3. Confusion
   4. Extreme thirst
   5. Increased urination
   6. Dehydration
   7. Kidney problems and even kidney failure
   8. Loss of appetite
   9. Weakness
   10. Drowsy
   11. Muscle spasm
3. Fatigue and weakness–  Anemic due to shortage of red cells
4. Recurrent infections – Due to insufficient WBC 
5. Easy bruising and bleeding  especially in the nose, gums and heavy periods – Due to inadequate platelets 
6. Weight loss
7. Kidney problem – Inability to remove water, salt and waste leads to
   1. Weakness
   2. Difficulty in breathing
   3. Itching
   4. Swelling of leg
8. If the spine bones are involved it causes:
   1. Back pain – severe and sudden
   2. Numbness – often in legs
   3. Muscle weakness – mostly in legs
9. Numbness – when nerves are affected
10. Slurred speech
11. Weakness in one side of the body
12. Hyper-viscosity: Due to increased protein in the blood, it becomes thicker. Can cause
    1. Heart failure – The heart has to work harder to pump blood
    2. Headache
    3. Visual disturbances

Why Does It Happen?

Researchers are yet to identify the exact cause of multiple myeloma. However, certain risk factors have been identified.

1. Age:  More common in people over 65 years
2. Gender: 1.5 times more common in men
3. Family history
4. Exposure to radiation, chemicals
5. Chromosomal abnormalities
6. Obesity

Monoclonal Gammopathy of Undetermined Significance (MGUS) is closely related. Here there is an overabundance of immunoglobulins in the blood. Approximately 1 in 100 individuals with MGUS go on to develop multiple myeloma each year. MGUS has no symptoms, so regular blood tests have to be done.

How is Multiple Myeloma Managed?

Currently, multiple myeloma cannot be cured. However, treatment can frequently assist to control the condition for several years. New medications, autologous stem cell transplantation, and improved supportive care have greatly improved survival rates.

How Are Multiple Myeloma Diagnosis Made by Medical Professionals?

For diagnosing and initiating early treatment a set of criteria and defining events are necessary. This involves getting various blood tests and imaging.  

Blood tests include:

1. Full blood count
2. Urea and creatinine
3. Calcium
4. Immunoglobulins
5. Serum free light chain

Imaging

1. CT Scan
2. MRI
3. Positron Emission Tomography (PET) – CT 

What Treatment and Management Options are Available?

Managing multiple myeloma requires a multidisciplinary approach of physicians, haematologists, radiologists, physiotherapists, dietitians and psychologists. The staging of the disease and symptoms dictate the treatment.

The therapy includes:

1. Initial induction regimen
2. Consolidation and/or maintenance therapy
3. Management of relapsed disease 

In first-line and relapsed settings, there is a combination of drugs used: 

1. Pain medications
2. Corticosteroids
3. Immunomodulators
4. Antibiotics
5. Proteasome inhibitors
6. Biphosphonates
7. Monoclonal antibodies
8. Immunotherapy
9. Chemotherapy
10. Supportive medicines
11. Stem Cell transplant
12. Radiotherapy
13. Surgery – to repair damaged bones or compressed nerve
14. Plasma exchange – if the blood has become thick
15. Transfusion of blood – for anaemia
16. Dialysis

You may feel tired and nauseous and may also experience diarrhoea, constipation, numbness of hands and feet, mood changes, increased hunger, and sleep disturbances. A more thorough knowledge about the side effects can be obtained from your healthcare professional. 

1. Looking after yourself is also equally important.

2. Adopt a balanced diet. A dietician can assist you in making the proper meal selections, particularly if you are having difficulty eating specific foods due to your therapy.

3. Exercise and stay active

4. Take pauses or naps as necessary

5. Explore support groups

Experiences with multiple myeloma will vary from person to person. Some people have years to live with few symptoms. Others see a rapid deterioration in their condition. Using blood tests like albumin and beta-2-microglobulin, DNA tests can predict survival rates. As you discover how to cope with multiple myeloma, connect with doctors and support groups for guidance. 

FAQs

1. Do I Have to Go For Follow-Up Treatments?

Ans: Yes, Kindly adhere to the doctors' advice. It is absolutely important to get regular blood tests and other investigations as advised.

2. What Precautions Should I Take During Treatment?

Ans: Eat healthy, exercise, protect yourself from infection and look after yourself. Take rest as and when needed.