Multiple Myeloma

shutterstock_239958094Multiple Myeloma is a rare cancer of bone marrow in which plasma cells, a natural part of our immune system, transform into malignant cells. Like many cancers, multiple myeloma is more common in the older age groups. Symptoms can include weakness, bone pain, and infections; other manifestations include low blood counts, high blood calcium, and kidney failure. Chemical and radiation exposure may cause multiple myeloma, but in most cases the cause is unknown.

A patient with suspicious symptoms will have blood tests, urine tests, and X-rays, which may reveal an abnormal M-spike protein, or moth-eaten bones caused by myeloma cells. A biopsy of bone marrow reveals the malignant plasma cells, which are tested for proteins and chromosomes to confirm the diagnosis. Further tests determine if it is early smoldering myeloma, Stage I myeloma, or more advanced Stage II or Stage III.

Although multiple myeloma is not considered curable, treatments can induce a remission, and some patients will survive for more than 15 years. Medications such as chemotherapy, steroids, and newer drugs are used to kill the myeloma cells. Some patients will have a stem-cell transplant. In this procedure, a patient’s own stem cells (adult stem cells) are removed from their body, frozen, and then put back into their body after they have been treated with a high dose of chemotherapy. The high dose of chemotherapy kills most myeloma cells, but also destroys the bone marrow. The stem cells given back to the patient after the high-dose chemotherapy will repopulate the bone marrow, reconstituting the blood-generating system and allowing the patient to again produce blood cells. After a stem cell transplant, a patient can stay in remission for years.

Another treatment is thalidomide, a drug found to cause birth defects when given to pregnant mothers in the 1960s, but now found effective in multiple myeloma, leprosy, and other conditions. Several other chemotherapy drugs and steroids are given in the event of a relapse.

Velcade is a new drug that kills myeloma cells. It is a magic bullet that binds and disrupts the cell mechanism called the proteosome, which functions to destroy old proteins. This year’s Nobel Prize in Chemistry was awarded for the discovery of this important drug target over 30 years ago.

A major complication of myeloma is bone erosion causing bone pain and sudden fracture. To treat bone erosion a drug called bisphosphonate is given, which reduces bone pain and fracture risk. This drug is similar to fosamax, which is given to patients with osteoporosis to strengthen their bones.

Another complication of multiple myeloma is serious infections, which are treated with powerful antibiotics. If the immune system weakens further the antibiotics become ineffective. Other problems include thick blood or low blood cells, which may require blood transfusions. Low blood counts occur when myeloma cells overgrow the normal stem cells in bone marrow.

With recent advances, patients with multiple myeloma can look forward to years of good quality living. Looking into the future, a cure seems a realistic goal.

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