Multiple myeloma: symptoms, causes & treatment

Definition

What is multiple myeloma?

Multiple myeloma is a type of blood cancer that develops in the plasma cells of the bone marrow.

Bone marrow is a soft tissue found in several parts of the bone cavity, where blood cells are produced. Plasma cells in the bone marrow are a type of white blood cell that plays an important role in the human immune system.

Normally, plasma cells produce antibodies or immunoglobulins that help the body fight infections and kill germs. However, when they develop into cancer, plasma cells actually produce abnormal proteins (antibodies) called monoclonal proteins or M proteins.

This M protein can cause damage to the kidneys, bone damage, and impaired immune function, so it can't help fight infections in the body. In addition, the development of myeloma cancer cells also causes the production and function of red and white blood cells to be disturbed, which can lead to anemia, thrombocytopenia, and leukopenia.

Myeloma cancer cells usually appear on the spine, skull, pelvis, ribs, arms, legs, and in the area around the shoulders and waist. This disease generally affects several parts of the body, which is why this condition is often called multiple.

Multiple myeloma is a disease that cannot be completely cured. Treatment is aimed at controlling the disease, relieving symptoms and complications, and extending the sufferer's life. Cancer cells can become inactive (dormant) for a few years, and then reappeared.

How common is multiple myeloma?

Multiple myeloma is a rare type of blood cancer. Only about 10% of cases of blood cancer are included in this type of disease. As for other types of blood cancer that are more common, namely leukemia and lymphoma (lymphoma).

This disease also ranks 22 in cancer cases that occur most often in the world. Based on 2018 Globocan data, as many as 159,985 new cases of myeloma in the world occur in a year. Meanwhile in Indonesia, the number of new cases of myeloma in the same year was 2,717 cases.

This type of cancer is more common in male patients than female. In addition, this disease is also more common in elderly patients, with an average age of over 60 years.

Multiple myeloma can be treated by recognizing existing risk factors. To find out more information about this disease, you can consult a doctor.

Signs & symptoms

What are the signs and symptoms of multiple myeloma?

Multiple myeloma signs and symptoms can vary. In fact, symptoms generally do not appear at the beginning or at an early stage.

However, the symptoms of multiple myeloma that may occur are:

• Bone pain, which is often felt in the back, hips, shoulders, or ribs.
• Weak bones to break easily (fracture).
• Symptoms of anemia, such as fatigue (fatigue), shortness of breath, and feeling weak.
• Frequent infections or infections that don't go away.
• Symptoms of hypercalcemia (too much calcium in the blood), such as frequent thirst, frequent urination, constipation, confusion, and frequent drowsiness.
• Unusual bruising and bleeding, such as frequent nosebleeds, bleeding gums, and heavy periods.
• Signs of kidney problems include nausea, loss of appetite, weight loss, dehydration, lack of energy, and swollen ankles, feet and hands.
• Nervous system disorders due to pressure on the spinal nerves (spinal cord compression), such as severe back pain, numbness (especially in the legs and arms), difficulty controlling the bladder or intestines, and erection problems.

Some of the other symptoms or signs may not be listed above. If you feel anxious about these symptoms, consult your doctor immediately.

When to go to the doctor

The symptoms above are not always caused by cancer. However, you should immediately consult a doctor if you experience the symptoms mentioned above, especially if they occur continuously and do not go away.

Each sufferer's body shows signs and symptoms that vary. To get the most appropriate treatment and according to your health condition, always consult a doctor.

Cause

What causes multiple myeloma?

Until now, the cause of multiple myeloma is not certain. However, experts believe that myeloma arises from damaged bone marrow plasma cells. Damage occurs due to mutated DNA in plasma cells.

DNA works by instructing how cells to replicate and develop. Healthy plasma cells usually develop at a normal rate, then die and are replaced by new cells.

However, the damaged plasma cells will continue to live and develop uncontrollably, causing a buildup and disrupting the production of healthy cells. However, unlike cancer cells in general, this abnormal buildup of cells does not form tissue or tumors.

These damaged cells will continue to produce antibodies, just like healthy plasma cells. However, these antibodies do not function as usual (monoclonal protein or M protein).

In some cases, multiple myeloma starts from a medical condition called monoclonal gammopathy of undetermined significance (MGUS). Each year, about one percent of people with MGUS develop this type of cancer.

Like myeloma, MGUS is also characterized by the production of M protein in the blood. However, in people with MGUS, M protein levels are lower and there is no risk of damaging the body.

Risk factors

What increases a person's risk of developing multiple myeloma?

Multiple myeloma is a disease that can affect anyone. However, there are several factors that can increase the risk of developing this disease.

Having one or more risk factors does not mean you will definitely get this disease. In some cases, sufferers of myeloma do not have any risk factors.

The following are the risk factors that trigger the emergence of this disease:

1. Increasing age

This disease is more common in patients aged 50 or 60 years and over. The incidence of this disease in patients under 40 years of age is very low.

2. Male gender

If you are male, your chances of getting this disease are higher than that of women. The cause of this is still not known with certainty.

3. A certain race

The number of cases of this disease is twice as common in black people than in white people.

4. Exposure to radiation

If you have been exposed to high or low levels of radiation for a long time, such as working in a special environment, your risk of developing this disease is higher.

5. Family history

If you have parents, siblings, siblings, or children who have this disease, you are two or three times more likely to have the disease.

6. Excess weight or obesity

Being overweight or obese can also increase the risk of developing cancer cells in the body, including myeloma.

7. History monoclonal gammopathy of undetermined significance (MGUS)

Myeloma sufferers generally already have previous MGUS disease. So, if you have MGUS, your chances of getting this type of cancer are greater.

8. Weak immune system

People with weakened immune systems as a result of treatment after an organ transplant have a greater risk of developing myeloma. In addition, the chances of getting this disease increase in people with HIV.

Diagnosis & treatment

The information described is not a substitute for medical advice. ALWAYS consult your doctor.

How is multiple myeloma diagnosed?

In some cases, multiple myeloma can be detected when you have a blood test for other medical conditions. However, in some other cases, myeloma is detected based on your symptoms.

In this case, the doctor will first ask about the risk factors you may have, your and your family history of the disease, and how long the symptoms have been on. Then, you will be asked to undergo a test. The tests for diagnosing multiple myeloma are:

1. Blood test

The medical team will perform a complete blood count test (complete blood count or CBC) to determine the levels of white, red blood cells and platelets in the blood. In addition, levels of creatinine, albumin, calcium, and other electrolytes will also be checked with blood chemistry tests, including levels of M protein produced by myeloma cells.

2. Urine test

Urine tests are carried out periodically to determine the presence of myeloma protein in urine that has been processed through the kidneys. This test is called urine protein electrophoresis (UPEP) and urine immunofixation.

3. Quantitative immunoglobulin test

This test calculates the blood levels of several types of antibodies, such as IgA, IgD, IgE, IgG, and IgM. If any of these components is excessive or too little, it is possible that cancer cells are developing in your bone marrow.

4. Electrophoresis

This procedure is the most accurate step in determining the presence of cancer in your bone marrow. Through this test, your doctor can detect any abnormal proteins in your blood, such as M protein.

5. Bone marrow biopsy

In this test, your doctor will take a sample of your bone marrow fluid using a needle. Then, the bone marrow fluid will be examined in the laboratory to see if there are myeloma cells in it.

6.Imaging tests (CT scan, MRI, or PET scan)

The doctor will also recommend imaging tests of the inside of your body, especially soft tissues such as the bone marrow.

How is multiple myeloma treated?

In some cases, people with this disease do not need treatment, especially if they do not feel symptoms. In this condition, you only need to undergo regular blood and urine tests to monitor the development of cancer cells.

Treatment is generally only given when symptoms appear. The treatment given depends on the health condition and how badly the cancer cells have developed.

The following are common treatments for multiple myeloma patients:

1. Targeted therapy

Targeted therapeutic drugs focus on disorders that cause cancer cells to survive. Targeted therapeutic drugs for myeloma include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro).

2. Biological therapy

Biological therapy drugs encourage the body's immune system to kill myeloma cells. In this type of treatment, the doctor will provide drugs, such as thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst).

3. Chemotherapy

Chemotherapy drugs can kill rapidly growing cancer cells, including myeloma cells. Medicines are usually given by mouth or by injection. This treatment is often done before bone marrow transplant.

4. Corticosteroids

Corticosteroid drugs, such as prednisone and dexamethasone, can help the body fight inflammation or inflammation. This can trigger the body's immune system to fight myeloma cells.

5. Bone marrow transplant

A surgical procedure is performed to replace the damaged bone marrow with new bone marrow.

6. Radiation therapy or radiotherapy

This procedure uses high-power light, such as X-rays and protons, to kill myeloma cells in the body.

Other medications and drugs may be given by your doctor according to your condition. Always consult your doctor for the right type of treatment.

Home care

What are some lifestyle changes or home treatments that can help treat multiple myeloma?

Lifestyle and home remedies below may help treat multiple myeloma:

• Knowing the condition, how to deal with symptoms, and side effects of treatment.
• Seek support from family, friends and colleagues.
• Take time to get enough rest.
• Adopting a healthy diet and getting enough exercise. If you have trouble eating, try dividing your meals into smaller, more frequent portions.
• Avoid overexerting yourself. If you still have to go to work or school during your treatment, you should discuss your abilities with this condition.

If you have any questions, consult your doctor to better understand the best solution for you.