Overview

Multiple Myeloma is a form of cancer that affects one of the types of white-blood-cells called plasma cells. Healthy plasma cells produce antibodies that fight pathogens and are vital for our immune system. When some of these plasma cells become cancerous and start multiplying uncontrollably, they crowd-out healthy plasma cells from the bone marrow. This directly affects the immune system, making the person prone to infections and disease. Further, these cancerous cells produce abnormal antibodies, which cause various complications. In this article, we will cover various facets of the condition.

Introduction

The three components of blood – red-blood-cells, white-blood-cells and platelets – are vital for human health as they perform various critical functions. While RBCs contain haemoglobin that acts as a carrier for oxygen, WBCs produce antibodies that help fight disease. Platelets help in clotting of blood thereby preventing blood-loss in the event of injury. All the three components of blood are produced in the bone-marrow.

The bone marrow is a soft, fatty tissue present in the central cavities or core of bones. This produces millions of new RBCs and WBCs every day, to replace dead and damaged ones. Like some other parts of the body, fat is also stored in the bone marrow and used as energy when required. Plasma cells or plasmacytes are a type of WBC that produce specific antibodies. They are vital for the immunity levels and hence health of a person.

Multiple myeloma (MM) is a condition in which plasma cells become cancerous. This affects their ability to produce desired antibodies in the desired quantity. This results in various complications in the body. The condition is not always fatal, and the recovery rate with long-term medication is encouraging.

Also Read: Types of Cancer Treatments

Causes and Risk Factors

What causes the plasma cells to become cancerous is not exactly understood till date. However, there are various risk-factors.

• Genetic mutations: Genes that are responsible for the growth and division of plasma cells develop abnormal mutations. Such mutations are generally:

1. tumour suppressor genes such as p53 genes
2. deletion of chromosome number 17
3. oncogenes such as MYC and RAS

• Gender: Men are more at risk than women.
• Age: Middle-aged people and seniors are at more risk than younger counterparts.
• Race: African and African-American people are more at risk than white Caucasians.
• Obesity: Obesity in early adulthood (late teenage) and late adulthood (late 50s to early 60s) increases the risk.
• Family history: A family history of MM increases the risk
• History of MGUS: Multiple myeloma starts off as a benign condition called as Monoclonal Gammopathy of Undetermined Significance (MGUS), which is marked by low levels of monoclonal antibodies in the blood. Earlier episodes of MGUS that were treated successfully, or a family history of MGUS, increases the risk.

Signs and Symptoms

The 6 prominent signs and symptoms are:

1. Fatigue. As MM reduces the count of healthy plasma cells, the body has to work harder to fight pathogens. This causes the person to tire easily.
2. Frequent infections. An extension of the above point. Fewer antibodies in the blood means, the body is fighting a losing battle against pathogens. So, the risk of infections and disease increases.
3. Bone problems. Since MM prevents the body from producing new bone cells, dead and damaged bone cells start accumulating. These leads to weak bones, fractures, bone pain, bone lesions and bone loss.
4. Blood problems: MM causes a drop in RBC count (anaemia), WBC count (leukopenia, which causes low immunity against infections) and platelet count (thrombocytopenia, which increases the risk of blood loss). The person can also have abnormal levels of calcium in the blood (Hypercalcemia) and thickened blood (Hyperviscosity).
5. Kidney problems. The harmful proteins produced by cancerous plasma cells and the hypercalcemia both cause kidney damage and eventually kidney failure.
6. Nervous system problems: As MM causes weakening of bones in the spine, the bones start collapsing and pressing on the spinal nerves. Called spinal cord compression, this condition leads to muscle weakness in legs, numbness and severe back pain. Also, the abnormal proteins produced by cancerous plasma-cells is toxic to the nerves. This leads to peripheral neuropathy that’s marked by weakness, numbness and tingling sensations (‘pins and needles’) in the lower limbs.

These 6 symptoms in turn cause other symptoms such as confusion or mental fogginess, nausea, constipation, weight-loss, loss of appetite, excessive thirst, fever and bruising.

Stages of MM

The disease starts and progresses in an expected fashion, which are demarcated as 4 stages. Assigning the correct stage helps doctors understand the risk, and decide the right course of treatment.

• Stage 1 – MGUS: Blood tests conducted for some other reasons shows up small amounts of the abnormal M protein. A tiny fraction of such people goes on to develop MM.
• Stage 2 – Isolated Plasmacytomas: Here, solitary or isolated clumps of abnormal plasma cells are found in the blood.
• Stage 3 – SMM: Smouldering Multiple Myeloma: As the name implies, multiple myeloma is just at the threshold. The blood shows small but significant presence of M protein while the bone marrow shows a high number of abnormal plasma cells in the bone marrow.
• Stage 4 – Multiple Myeloma: There are multiple clumps of abnormal plasma cells in the blood, high levels of M protein in the blood and high levels of abnormal plasma cells in the bone marrow.Also Read: A Glance at the Past, the Present and the Future: Individualised Cancer Care

Also Read: A Glance at the Past, the Present and the Future: Individualised Cancer Care

Diagnosis

A range of tests are done to confirm or rule-out MM:

• Complete blood count (CBC): This test will determine if the number of RBCs and WBCs in the blood are normal, and if the concentration of haemoglobin in RBCs is normal.
• Blood chemistry test: This test looks for levels of creatine (indicator of kidney function), albumin (a protein), calcium and LDH (lactic dehydrogenase levels, a tumour marker) in the blood.
• Quantitative immunoglobulin test: The levels of certain antibodies in the blood are measured.
• Electrophoresis: This test helps detect M proteins in the blood.
• Urine tests: This looks for Bence Jones protein in the urine which is one of the signs of MM.
• X-rays: Looks for damage in bones due to MM
• CT scan: Looks for bone damage.
• MRI scan: A combination of magnets and radio-waves are used to create images of the bones and spine, and also look for isolated groups of abnormal plasma cells.
• PET scan: This too looks for isolated groups of abnormal plasma cells (plasmacytomas).
• Bone marrow biopsies: A biopsy of the bone marrow tissue helps derive the percentage of healthy vs unhealthy plasma cells. The bone marrow sample can also be examined for DNA changes that can trigger cancerous growths.

Treatment

1. Medications

• Painkillers: These provide relief against bone pain
• Antibiotics: These help fight infection-causing pathogens
• Steroids: These kill cancer cells and help reduce inflammation

2. Therapies

• Chemotherapy: These help kill abnormal plasma cells and hence reduce their number
• Immunotherapy: This treatment boosts the immune system so that it can produce more cancer-fighting cells.
• Radiation therapy: This treatment kills cancer cells and arrest tumours in the bone.

3. Transplant

Stem-cell transplant: Stem cells are a special type of cells found in the bone-marrow or blood. Their role is to produce new and healthy plasma cells. By injecting stem cells taken from the bone marrow of a healthy person into that of a patient with MM, the percentage of healthy vs unhealthy stem cells increases. The new stem cells produce healthy plasma cells, increasing their percentage as compared to unhealthy plasma cells.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.

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