Multiple myeloma is a relatively uncommon cancer formed by malignant plasma cells, which affects the immune system. This year, it is estimated that more than 24,000 people will be diagnosed with multiple myeloma, and more than 11,000 people will die from it.
The immune system is made of various types of cells that, together, work to fight infection and disease. Lymph cells, called lymphocytes, are the main cell type of the immune system, with two major forms of lymph cells: T cells and B cells. To fight an infection, B cells mature and change into plasma cells. Plasma cells produce immunoglobulins, which in turn help the body attack and kill germs. Lymph cells are in many different parts of the body including the lymph nodes, bone marrow, the intestines, and the bloodstream. Plasma cells are found mainly in bone marrow, the soft tissue inside hollow bones. When plasma cells turn cancerous and grow out of control, they produce a tumor called plasmacytoma. These tumors are sometimes found in other tissues, but mostly develop in a bone. If a person has more than one plasmacytoma tumor, he has multiple myeloma.
In some cases, patients show no symptoms of multiple myeloma at all. Symptoms include weight loss/loss of appetite, bone pain, frequent infection, excessive thirst, and numbness in the legs. Multiple myeloma is characterized by the following:
- Low blood counts: The overgrowth of plasma cells in bone marrow can crowd normal blood-forming cells, leading to low blood counts and anemia. Platelet levels also decrease, which can lead to increased bleeding and bruising. If there is shortage of white blood cells, a person can develop leukopenia, which makes fighting infections even more difficult.
- Bone and calcium problems: Bones are constantly being remade to remain strong, and two types of cells work together to achieve this: osteoblasts and osteoclasts. Osteoblasts lay down new bone, and osteoclasts break down the old bone. Myeloma cells produce a substance that tells osteoclasts to speed up dissolving the bone before osteoblasts are able to make a new bone. This weakens bones, making them easier to break and fracture.
- Infections: Normal plasma cells produce antibodies that attack and kill bacteria causing an illness. Myeloma cells crowd normal plasma cells, preventing antibodies from attacking infection.
- Kidney problems: The antibody made by myeloma cells can harm the kidneys, leading to kidney damage and sometimes, kidney failure.
- Monoclonal gammopathy: Myeloma cells are copies of the same antibody. Having copies of the same antibody is known as monoclonal gammopathy, which can be found with a blood test. Although everyone with multiple myeloma has monoclonal gammopathy, not everyone with monoclonal gammopathy has multiple myeloma, because it can occur by itself, or in other diseases as well.
- Hyperviscosity: In some cases, large amounts of myeloma protein cause the blood to “thicken”, called hyperviscosity. This can slow blood flow to the brain and cause confusion, dizziness, and stroke-like symptoms.
- Light chain amyloidosis: Antibodies are made up of protein chains linked together: two short, lighter chains and two longer, heavy chains. Abnormal plasma cells produce too many light chains, which can deposit in tissues and build up, the accumulation of which is called an amyloid. An amyloid buildup in certain organs, such as the heart, can lead the organs to enlarge and not work efficiently.
If symptoms suggest a person has multiple myeloma, x-rays of the bone, bone marrow biopsies, and lab tests on the blood and/or urine are typically administered. These tests and procedures are done to examine kidney function, blood cell counts, calcium levels, and to measure the rate at which the myeloma cells are dividing. If a patient shows no symptoms, immediate treatment may not be necessary, but the patient will still be monitored and tested regularly to look for signs the disease is progressing.
Although there is no cure for multiple myeloma, with treatment patients can return to near-normal activity. Treatment can help relieve pain, control complications of the disease, stabilize the patient’s condition, and slow the disease’s progress. Typically, combinations of treatments are given to patients to fight multiple myeloma. The amounts and type of treatment depend on the patient’s age, overall health, and risk of the disease progressing.
Standard treatment options include:
- Targeted Therapy: Targeted drugs are administered to block the action of myeloma cells breaking down proteins, which causes the cells to die.
- Biological Therapy: The patient takes pills to enhance the immune system cells that identify and attack cancer cells. These pills use the body’s immune system to fight the myeloma cells.
- Chemotherapy: Chemotherapy drugs kill fast-growing cells, like myeloma cells. Chemo can be administered through a vein, or in pill form.
- Stem Cell Transplantation: This procedure replaces diseased bone marrow with healthy bone marrow. Blood-forming stem cells are collected from the patient’s blood and after high doses of chemotherapy to destroy the diseased bone marrow, the stem cells are infused into the body to begin rebuilding bone marrow.
- Radiation Therapy: Radiation uses beams of energy, such as x-rays, to damage myeloma cells and stop their growth. Radiation may be used to quickly shrink cells in a targeted area that is causing pain or destroying a bone.
If you are experiencing symptoms of multiple myeloma, or have questions about treatment options, consult the specialists at Southeastern Medical Oncology Center. We can recommend appropriate treatment options based on your age, health, and symptoms.