Myeloma (multiple myeloma) is the second most common blood cancer diagnosed after non-Hodgkin’s lymphoma, but very few people know much about the deadly disease.
A myeloma is a cancer that develops from plasma cells. A plasma cell is a type of white blood cell created in the bone marrow.
Overview of myeloma (multiple myeloma)
Bone marrow is a porous material inside our bones. It is part of the body’s immune system, helping to protect us from infections and diseases.
Bone marrow makes all the blood cells needed for the body. All blood cells in the bone marrow start as stem cells. These stem cells then develop into three different types of blood cells:
- Red blood cells: carry oxygen to all cells in the body
- White blood cells: fight infection
- Platelets: helps blood to clot and control bleeding
Plasma cells are a type of white blood cell that fight infection. It produces immune globulin also known as antibodies. They move in the blood and help fight off any viruses or bacteria in the body.
If you have an infection your bone marrow produces more plasma cells and immune globulins to fight off anything that causes the infection.
Plasma cells in myeloma
Usually plasma cells are made in a controlled manner. But in people with myeloma this process is out of control and a large number of abnormal plasma cells (myeloid cells) are created.
Myeloma cells fill the bone marrow and can damage the bone. This can cause osteoporosis, pain and sometimes fractures. Bone marrow cells can spread from bone marrow to bone in different parts of the body. This is why myeloma is sometimes called multiple myeloma.
If the bone marrow is full of bone marrow cells it may be difficult to make enough normal white blood cells, red blood cells and platelets.
The tumor cells make an abnormal type of immune globulin that cannot fight infection. This can be any one of five types of immunoglobulin (IgA, IgD, IgE, IgG or IgM). The abnormal immune globulin is called paraprotein or M protein.
If you have myeloma you can make less normal immune globulins. This means it can be harder for your body to fight off infection.
Types of myeloma
There are many different types of myeloma. The type of myeloma you are diagnosed with usually does not change the treatment you give. The main types of myeloma include:
- Multiple myeloma: the most common, over 90% of people with myeloma have this type. Multiple myeloma affects a number of different areas of the body.
- Plasmacytoma : there is only one location of apparent osteoblast cells in the body such as in bone, skin, muscle or lung.
- Local myeloma : some surrounding areas are affected.
- Osteoblastoma: involvement of tissues other than bone marrow such as skin, muscle or lung.
What is myeloma?
Doctors don’t know why some cells become osteoblasts and others don’t. For most people with myeloma there is no clear reason why they develop the disease.
There are several factors that can increase your risk of developing myeloma, including:
- Age: Most people who develop myeloma are over 50 years old. Few myeloma cases occur in people under 40 years of age.
- Gender: More men develop myeloma than women.
- Race: Canadians are nearly twice as likely to develop myeloma compared to whites.
- Medical history: People with a history of diagnosis of MGUS (monoclonal pathology has no significance).
- Environment: Several studies have shown a link between the growth of myeloma and radiation or exposure to certain chemicals such as pesticides, fertilizers and Agent Orange.
- Obesity: New research shows that obese people have a higher rate of myeloma.
At an early stage, myeloma may not cause any symptoms. It is usually only suspected or diagnosed after a routine blood or urine test.
Myeloma causes a range of problems including:
- a dull aching ache or aching areas in your bone
- weak brittle bones
- Fatigue, weakness and shortness of breath: caused by anemia
- Repeated infections: Germ cell tumors inhibit your body’s ability to fight infections.
- Kidney problems: Myeloma can cause problems with kidney function, including kidney failure. Higher blood calcium levels associated with bone erosion may interfere with the kidney’s ability to filter waste products from the blood.
less common: unusual bruising and bleeding, such as frequent nose bleeds, gum bleeding and severe periods
Myeloma usually does not cause a lump or tumor. Instead it damages the bones and affects the production of healthy blood cells.
Diagnosis of myeloma
A series of tests or investigations will be done to confirm or rule out myeloma diagnosis and check your general health. These tests may include:
- Blood test: to check the level of normal blood cells, calcium levels and the presence of M protein made by myeloid cells
- Urine test: to detect the presence of M-protein
- X-ray bone: to check for any lesions or fractures
- Sestamibi scan: to look for bone changes
- Bone marrow test: to look at the cells in the bone marrow and count the number of plasma cells. A biopsy involving a small amount of fluid and a small core of bone marrow is removed. The presence of abnormal chromosomes can also be determined.
If these tests show that you have multiple myeloma you will need further tests to find out how myeloma affects your body. This usually means extra blood tests and possibly CT scans and MRI scans.
Method of treating myeloma is what?
Myeloma is treatable but currently there is no cure. The goal of myeloma treatment is to slow down the development of the disease, control all symptoms and keep the tumor cell tumors low. Standard treatments for myeloma include:
- Chemotherapy: Cancer killer drugs are given in the form of injections or pills.
- Radiation therapy: X-rays are used to target and kill cancer cells. Radiation therapy also helps reduce pain and reduce the risk of bone fractures.
- Steroids: often given by injection or as tablets with chemotherapy help make treatment more successful.
- Thalidomide: thought to work by slowing the growth of blood vessels around abnormal plasma cells, it is used in the form of tablets.
- Lenalidamide: believed to work by destroying tumor cells and modifying the immune system, it is used in the form of tablets.
- Bortezomib: believed to work by destroying tumor cells, it is carried out in the form of an injection.
- Stem cell transplant: all blood cells come from stem cells in bone marrow. High doses of chemotherapy can damage these cells, so stem cells are removed from the bone marrow before taking higher doses of chemotherapy. The stem cells are re-implanted after chemotherapy is finished.
- Bisphosphonates: used to treat high calcium levels to strengthen bones and relieve pain, it can be injected as an injection or taken as a tablet.
- Surgery: weak or thin bones may need to be strengthened with plates, pins or screws.
- Plasmapheresis: can be used to eliminate abnormal proteins produced by osteoblastoma cells. This prevents blood from clogging small blood vessels that can cause confusion, dizziness and stroke-like symptoms. This is not a common treatment but the procedure may be recommended if abnormal protein levels are generated by dangerously high plasma cells.
- Clinical trials: aims to discover new and improved treatments for multiple myeloma. Ask your doctor what tests are available and if you can qualify.
If you have multiple myeloma but don’t experience any symptoms, you may not need treatment. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may involve periodic blood and urine tests.
Treatment of complications
Because multiple myeloma can cause a number of complications, you may also need treatment for such specific conditions:
- Bone pain: Pain relievers, radiation and surgery can help control bone pain.
- Kidney complications : People with severe kidney damage may need dialysis.
- Infections: Your doctor may recommend certain vaccines to prevent infections, such as flu and pneumonia.
- Bone loss: Your doctor may recommend medications called bisphosphonates such as pamidronate (Aredia) or zoledronic acid (Zometa) to help prevent bone loss.
- Anemia: If you have persistent anemia, your doctor may recommend medication to increase your red blood cell count.
Prospects for myeloma patients
The outlook for myeloma is improving all the time, but the condition is still not completely cured. Research is ongoing to try to find new and better treatments.
Like other types of cancer the outlook depends on things like your age and your general health. Some people may live for less than a year, while others may live for 20 years or more.
Source of Myeloma:
- Source myeloma.org.uk article What is myeloma : https://www.myeloma.org.uk/understanding-myeloma/what-is-myeloma/ , copyright Myeloma UK 2019.
- Source Cancer.org article What Is Multiple Myeloma : https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html , updated 2/28/2018.
- What are reputable sources index-china.com summarizing the article about myeloma? Causes, symptoms, treatment of bone marrow cancer: https://index-china.com/myeloma/ , updated 14/3/2020.
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Vietnamese health.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.