What is Multiple Myolema?
Multiple myeloma (also simply referred to as myeloma) is a cancer that originates from plasma cells in the bone marrow. Mutations in the genes of plasma cells can turn them into myeloma, and unlike normal plasma cells, myeloma cells produce new cells that are not needed and do not die when old or damaged. Myeloma cells successively make more copies of themselves.
As a result, a cluster of myeloma cells forms, all with the same genetic defect.
Myeloma cells are diseased plasma cells that still produce immunoglobulins. These immunoglobulins are ineffective, they are all the same they are called monoclonal because they originate from the same clone, they accumulate in the blood and are eliminated through the urine.
Therefore, in a patient with multiple myeloma, it is very important to have a blood test to find these immunoglobulins.
Prevention
There are no prevention or screening strategies for multiple myeloma.
Your attending physician will be attentive to your routine blood tests and any symptoms you may have.
Multiple Myeloma Subtypes
It is important to distinguish between isolated or solitary plasmacytoma and multiple myeloma.
Plasmacytoma is an accumulation of diseased plasma cells in a single bone site, usually a vertebra.
Multiple myeloma is a disease in which there are diseased plasmocytes that cause multiple bone lesions, in addition to changes in the functioning of the bone marrow, conditioned by the occupation of the marrow by these diseased cells.
Risk factors
Any behavior or condition that increases your risk of having a disease is a risk factor. If one or more risk factors apply to you, it does not mean that you will necessarily develop multiple myeloma. Likewise, multiple myeloma can appear in individuals who have no known risk factors.
It has not yet been possible to find the causes for multiple myeloma, but some risk factors are known. Some of the main risk factors are given below :
Age - Most diagnoses of multiple myeloma refer to individuals over 65 years old;
Being male - The incidence is higher in men, although the reasons for this are not known;
Personal history of monoclonal gammopathy of undetermined significance - In this pathology that is not malignant in nature and is a laboratory finding of an abnormal immunoglobulin, and occurs when some plasma cells produce immunoglobulins all the same (monoclonal). It may evolve to myeloma over years or decades. It is not treated and the level of immunoglobulins must be monitored;
Family history of multiple myeloma - Studies indicate that the risk increases if you have direct family members with a history of the disease.
Multiple myeloma symptoms
As a result of plasma cell tumors' propensity to penetrate bone, back, rib, and hip discomfort might develop. Complications lead to further symptoms.
Complications
• When plasma cell tumors weaken the bones and induce osteoporosis or osteoopenia, fractures may result.
• Also, the release of calcium from bones can result in abnormally high levels of calcium in the blood and possibly cause constipation, increased frequency of urination, kidney problems, weakness and confusion.
• Decreased production of red blood cells often leads to anemia which in turn causes fatigue, weakness and paleness and can lead to heart problems. Decreased production of white blood cells leads to repeated infections, which can cause fever and chills. Decreased production of platelets compromises the blood's ability to clot and results in easy bruising or bleeding.
• Fragments of monoclonal antibodies, known as light chains, often end up in the kidneys' collection system and sometimes permanently damage the kidneys by interfering with their filtration function, which leads to kidney failure. Fragments of light chains from antibodies present in the urine (or blood) are called Bence-Jones proteins. The increase in the number of developing cancer cells can cause overproduction and excretion of uric acid in the urine, which can result in kidney stones. Deposits of certain types of antibody fragments in the kidneys or other organs can lead to amyloidosis, another serious disorder found in a small number of people with multiple myeloma.
• In rare cases, multiple myeloma interferes with blood flow to the skin, fingers and toes, nose, kidneys, and brain because the blood becomes thick (hyperviscosity syndrome).
Diagnosis of multiple myeloma
• Laboratory tests
• Bone marrow biopsy
• X-rays or other imaging tests (positron emission tomography in conjunction with computed tomography, magnetic resonance imaging, etc.)
When lab tests conducted for another reason reveal high protein levels in the blood or urine, or when an x-ray obtained for another reason reveals particular regions of bone loss, multiple myeloma can be identified even before patients have symptoms. Bone loss can be widespread or, more often, appears as isolated lytic lesions in the bones.
Multiple myeloma is sometimes suspected because of symptoms such as back pain or bone pain elsewhere, fatigue, fevers, and bruising. Blood tests done to look for such symptoms may reveal that a person has anemia, a low white blood cell count, a low platelet count, or kidney failure.
The most useful laboratory tests are protein electrophoresis and serum and urine immunoelectrophoresis. They detect and identify the overabundance of a single type of antibody found in most people with multiple myeloma. Additionally, doctors check for various antibodies, including IgG, IgA, and IgM. Multiple myeloma of the IgD and IgE forms is relatively uncommon. Additionally, calcium levels are frequently assessed.
The quantity and kinds of protein in a urine sample taken over a 24-hour period are evaluated. Half of those who have multiple myeloma have Bence-Jones proteins in their urine, which are a component of the monoclonal antibody.
Bone marrow aspirate and biopsy is performed to confirm the diagnosis. In people with multiple myeloma, bone marrow samples reveal large numbers of plasma cells that are abnormally arranged in layers and clumps. Individual cells can also look abnormal.
In addition, other blood tests are helpful in determining advanced multiple myeloma status (score).When a person is diagnosed with the condition, certain changes in the levels of particular proteins (for example, greater levels of beta-2 microglobulin and lower levels of albumin) in their blood often signal the chance of a shorter survival and are likely to influence treatment choices. In addition, specific chromosomal abnormalities and higher serum lactate dehydrogenase levels indicate shorter survival as part of staging.
Even if radiographic findings suggest the diagnosis, imaging is necessary to determine which bones are affected. Whole-body x-rays (bone scans) are usually taken. Magnetic resonance imaging (MRI) or positron emission tomography (PET) combined with computed tomography (CT) may also be performed to look at specific sites of bone pain.
Multiple myeloma prognosis
Multiple myeloma presently has no known therapy, yet the majority of patients benefit from it. There are now more effective therapies available. As a result, median survival practically doubled. But survival time varies widely depending on certain features at diagnosis and response to treatment, including
*kidney problems
*Certain proteins, such as beta2-microglobulin, serum albumin, and lactate dehydrogenase (LDH), are present in the blood at varying quantities.
*Genetic characteristics in cancerous plasma cells, including specific chromosomal abnormalities and gene changes.
Multiple myeloma patients now have a better chance of survival because to newer medications. Better painkillers, growth factors—substances that encourage the creation of blood cells to increase the quantity of red and white blood cells—and bisphosphonates, which are infused monthly to decrease bone issues, have all contributed significantly to quality of life improvement.
People who survive for many years after successful treatment for multiple myeloma sometimes develop leukemia, or irreversible loss of bone marrow function. These late complications can result from chemotherapy and often lead to severe anemia and an increased sensitivity to infections and bleeding.
Because multiple myeloma is ultimately fatal, people with multiple myeloma can benefit from end-of-life care discussions that involve their physicians and relatives and friends, as appropriate. Discussion topics may include advanced instruction, use of feeding tubes, and pain relievers.
Multiple myeloma treatment
★Some combination of several types of drug (eg, corticosteroids with one of the immunomodulatory agents thalidomide, lenalidomide, or pomalidomide, and/or the proteasome inhibitors bortezomib, carfilzomib, or ixazomib; or the nuclear export inhibitor selinexor). Furthermore traditional chemotherapy drugs can also be used in combination with these types of drugs.
★Monoclonal antibodies (eg, elotuzumab, isatuximab, and daratumumab), most commonly combined with steroids and an immunomodulatory agent or proteasome inhibitor
★Possibly stem cell transplant
★Possibly radiation therapy to treat bone pain
★Treatment of complications
Multiple myeloma remains incurable despite significant recent advances in its treatment. Treatment aims to prevent or alleviate symptoms and complications by destroying abnormal plasma cells and delaying disease progression.
Typically, treatment doesn't start until the individual experiences symptoms or consequences, but in some cases, even in asymptomatic patients with high-risk characteristics, therapy may need to start right away. These high-risk characteristics include more severe illness, higher amounts of certain proteins in the blood, and particular genetic abnormalities in tumor cells.
By killing aberrant plasma cells, a variety of medications are frequently used to decrease the progression of multiple myeloma. Depending on the myeloma's features and whether or not a patient qualifies for a stem cell transplant, doctors may utilize a variety of medication combinations. Combinations can include drugs from each or more of the following:
★An immunomodulatory agent (thalidomide, lenalidomide, or pomalidomide) and/or proteasome inhibitor (bortezomib, carfilzomib, or ixazomib), combined with corticosteroids (such as dexamethasone, prednisone, or methylprednisolone)
★More traditional chemotherapy drugs
★The monoclonal antibodies elotuzumab, isatuximab, and daratumumab
Alkylating agents (melphalan, cyclophosphamide, or bendamustine) or anthracyclines (doxorubicin or its pegylated liposomal version) are two common chemotherapy medications. Because chemotherapy destroys both normal and abnormal cells, people's blood counts are monitored and the dose is adjusted if the number of normal white blood cells and platelets drops too low.
Doctors sometimes recommend stem cell transplantation for people who are in good baseline health and whose myeloma has responded to several cycles of drug treatment. Stem cells (non-specialized cells that develop into immature blood cells, which eventually mature into red blood cells, white blood cells, and platelets) are collected from the person's blood before high-dose chemotherapy is given. After the high-dose therapy, these stem cells are subsequently given back (transplanted) to the patient. This surgery is often only performed on patients under the age of 70. Stem cell transplantation is nevertheless being utilized less frequently since a lot of the more recent medication combinations are quite successful.
Powerful pain relievers and radiation therapy directed at the affected bones can help relieve bone pain, which can be severe. Radiation therapy can also prevent fractures from developing. However, radiotherapy can impair bone marrow function, which can affect a patient's ability to be treated with myeloma drugs. Monthly intravenous administration of pamidronate (a bisphosphonate – a drug that slows the loss of bone density) or the more potent drug, zoledronic acid, can reduce the development of bone complications. Most people with multiple myeloma are given these drugs for the rest of their lives as part of their treatment. Denosumab given monthly may be an option for patients who cannot tolerate zoledronic acid or have poor kidney function. People are encouraged to take calcium and vitamin D supplements to help reduce bone loss, as long as they do not have high blood calcium levels. Doctors also encourage them to stay active, as this helps prevent bone loss. Prolonged bed rest tends to accelerate bone loss and makes bones more vulnerable to fracture. Most people can lead a normal lifestyle and do most activities.
Drinking plenty of fluids dilutes the urine and helps prevent dehydration, which can make kidney failure more likely. People who develop kidney problems may benefit from plasmapheresis.
People who show signs of infection (fever, chills, coughing up sputum, or reddened areas of the skin) should see a doctor right away, as they may need antibiotics. People may also be at risk for shingles infections, particularly when they are treated with specific myeloma drugs, such as any of the proteasome inhibitors (including bortezomib, carfilzomib, or ixazomib) or monoclonal antibodies (including daratumumab or elotuzumab). An oral antiviral drug called acyclovir taken long-term can help prevent herpes infections. Since people are at increased risk of infections, they should receive pneumococcal and influenza vaccines.
People with severe anemia may need red blood cell transfusions. Erythropoietin or darbepoetin, drugs that stimulate the formation of red blood cells, may fight anemia adequately in some people. Some people with anemia also benefit from taking iron supplements.
Elevated blood calcium levels can be treated with intravenous fluids and often require intravenous bisphosphonates. Avoiding foods that contain vitamin D and calcium is also helpful in reducing high calcium levels.
People with high blood uric acid levels or widespread disease may benefit from allopurinol, a drug that blocks the body's production of uric acid, which can damage the kidneys.
