Myeloma

What is Myeloma?

Myeloma (also known as multiple myeloma or plasma cell myeloma) is a type of blood cancer that develops from plasma cells (a type of white cells in the bone marrow). Plasma cells produce proteins called “antibodies” which help to fight infections. In contrast, myeloma cells produce abnormal proteins called “paraproteins” which are non functional but can deposit in the body causing tissue or organ damage.

Who can get myeloma?

Myeloma is the second most common blood cancer in the world accounting for  nearly 10% of all hematological cancers. It is twice more likely to occur in people of African descent. Nearly all cases occur after the age of 40 years and it mostly affects elderly men.

What are the signs and symptoms?

Bone pain is the commonest symptom experienced in myeloma. Usually back pain but any bone could be affected. The pain can also result from a collapse of the back bone or fracture of any bone without any trauma.

The abnormal cells in the marrow crowds out the normal cells leading to reduction in red cell production and anemia results. Symptoms of anemia include weakness, fatigue, breathlessness etc.

Due to lack of/or reduced production of the normal antibodies, myeloma predisposes to infections from bacteria, viruses and fungi.

The abnormal proteins (paraproteins) deposit in tissues and organs causing damage. The kidney is mostly affected leading to kidney failure.

How is myeloma diagnosed?

A biopsy is needed to diagnose myeloma. This is usually a bone marrow biopsy but could also be a biopsy of a swelling where myeloma is suspected. Other tests required include blood tests (serum protein electrophoresis, serum free light chain ratio), urine test (urine protein electrophoresis), imaging (x-rays, CT scan or MRI). Other tests used for identifying complications, staging or monitoring response to treatment include complete blood count, erythrocyte sedimentation rate (ESR), renal function test, blood levels of calcium, lactate dehydrogenase, albumin and beta2-microglobulin, and chromosomal studies including fluorescent insitu hybridization (FISH).

What are the stages of myeloma?

Myeloma is staged to determined the extent of the cancer and to determine the prognosis. There have been different staging system. The current staging system make use of some blood parameter to determine the stage. The Revised International Staging System (R-ISS) has 3 stages based on the blood lactate dehydrogenase, albumin and beta2-microglobulin levels and chromosomal studies including fluorescent insitu hybridization (FISH).

How is myeloma treated?

The treatment of myeloma involves the use of medications to reduce the burden of the myeloma cells in the body and well as to treat the complications of myeloma.

The choice of medications for initial treatment is usually determined by the eligibility for stem cell transplantation. A combination of medications are used at cycles of intervals to ensure the resolution of symptoms and reduction in the abnormal proteins produced by the myeloma cells. The choice of the medications depends on the disease and patients characteristics.

If the individual is eligible for transplant, this is usually done after a significant reduction in the cancer burden following medical treatment. The type of transplantation is one in which the individual’s own stem cells are reintroduced into the body after harvesting them following some very intensive treatment to wipe out all the myeloma cell. This form of transplantation is called autologous stem cell transplantation.

The use of radiotherapy may also be indicated for bone involvement of the back or other specific regions of the body.

What are the complications of the treatment?