A picture of a man holding his knee, with a drawing of his leg bones overtop of his skin because he has multiple myeloma

Understanding Multiple Myeloma?

Multiple myeloma is a type of cancer that forms in white blood cells. Luckily, there are different treatment options for it, which we will discuss in this article along with signs and symptoms, and how to get a diagnosis.

Also called Kahler Disease, it is cancer that attacks the plasma cells. Cancerous plasma cells rapidly duplicate due to the cells’ multipotent nature and outnumber the healthy white and red blood cells. Cancerous plasma cells make their antibodies called monoclonal proteins, whose build-up causes organ damage.

Different Types of Multiple Myeloma

There are three types characterized by how they impact the body:

  • Monoclonal gammopathy of undetermined significance (MGUS) is a pre-cancerous condition with a small amount of myeloma in the bone marrow. MGUS has no symptoms, and patients are required to go for a check-up every six months to monitor and ensure the condition does not graduate to active myeloma. Even though they are few, not all patients with MGUS get myeloma.
  • Indolent myeloma, also known as smoldering myeloma, has no symptoms. A patient with indolent myeloma has more myeloma cells than the MGUS individual. In the cause of smoldering myeloma, abnormal protein can be found in the urine and bone marrow, and eventually, the myeloma becomes active.
  • Active (symptomatic) myeloma is the overt cancer stage. At this stage, the disease is causing bone and kidney damage, anemia, and high calcium levels.

Signs and Symptoms

The International Myeloma Working Group defined myeloma symptoms into the synonym CRAB, which stands for:

  • Calcium in high levels also known as hypercalcemia.
  • Renal failure.
  • Anemia.
  • Bone disease.
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The high levels of calcium (hypercalcemia) in the blood occur is due to the breakdown of the bone. Hypercalcemia can cause the following symptoms:

  • Excessive thirst.
  • Nausea.
  • Vomiting.
  • Loss of appetite.
  • Constipation.
  • Confusion.

Excess levels of monoclonal protein in the blood causes renal failure. Anemia is due to a lack of enough red blood cells to transport oxygen around the body. Anemia symptoms include fatigue, irritability, and dizziness.

The ribs, pelvis, back, and skull can also become prone to injuries owing to bone damage.

Other symptoms of myeloma can include:

  • Weakness or numbness in the legs
  • Vision challenges.
  • Problems with urination.
  • Frequent infections.
  • Weight loss.
  • Bone pain in your spine or chest.

Getting a Diagnosis

Even without symptoms, doctors routinely carry out blood and urine tests for myeloma to check for monoclonal and beta-2 microglobulin proteins.

Blood tests also ascertain:

  • Red and white blood cell count.
  • Percentage of plasma cells in the bone marrow.
  • Kidney function.
  • Uric acid.
  • Calcium.

Doctors may also carry out imaging tests such as CT scans, x-rays, and MRI scans to check for bone damage. Lastly, doctors may perform a biopsy, through which they extract tissue samples from the bone marrow and test for the cancer.

Once the doctors determine that you have cancer they will establish what stage it has progressed to. During staging, the doctor will carry out blood count cells, hemoglobin, albumin, and calcium levels tested in the blood and urine as applicable. Imaging may also be done to document the extent of bone damage, if any.

There are three stages, according to the Durie-Salmon Staging system, referred to as stage 1, stage 2, and stage 3.

Treatment Options

Treatment depends on the type or stage of multiple myeloma. MGUS is often treated with radiotherapy or chemotherapy and surgery to remove cancer if it is not inside a bone.

Smoldering myeloma can go for years without starting treatment. The patient is closely monitored since the disease may develop into active myeloma. Studies show that treatment with drug therapies of lenalidomide (Revlimid) and dexamethasone help patients live longer.

Lastly, a patient with active myeloma is also given drug treatment depending on the extent of kidney function, and if stem cell transplant is part of the process. Bortezomib, lenalidomide, and dexamethasone combinations are the drugs given to patients. Bortezomib is particularly useful for patients with kidney problems.

Chemotherapy and radiation therapy are also used in instances where there is bone damage.

Other support treatments such as blood transfusions, intravenous immunoglobulin (IVIG), and antibiotics are also administered to patients. Patients may undergo stem cell transplant as part of the treatment and may be given consolidation treatments, which are additional treatment cycles after the transplant.

After the transplant, a combination of lenalidomide and bortezomib may be administered to help delay myeloma’s return but with serious side effects.