Multiple myeloma: overview and more

Multiple myeloma (also called myeloma) is a rare and incurable type of blood cancer, also known as hematologic cancer. It affects cells called plasma cells, which are types of white blood cells. Normal plasma cells make antibodies to help the body fight infection. Myeloma includes malignant plasma cells that accumulate in the bone marrow or soft tissues in the center of the bones.

The term "malignant" describes the tendency to progressively deteriorate, invade, and destroy nearby tissues by spreading (metastasizing) to other parts of the body. Myeloma is considered a devastating plasma cell disease that can lead to many complications, including bone fractures, kidney problems, and other blood cell disorders.

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Although multiple myeloma is believed to have existed since ancient times, the first confirmed case was documented in 1844. This was the case of Thomas Alexander McBean in London. In 1889, the disease became more recognizable after the reported case of a subject who survived for 8 years without any chemotherapy treatment.

Over time, new drugs (as well as stem cell transplant therapy) have emerged to treat myeloma. Although the disease is not considered curable, it has become a disease that is considered easily manageable thanks to the rapid development of medicine, especially during the last decade.

In fact, according to the Multiple Myeloma Research Foundation (MMRF), the development of new therapies has resulted in the approval of up to 10 new drugs in the time it typically takes to obtain medical approval for a single drug.

Statistics in the US

Multiple myeloma accounts for just over 10 percent of all blood cancers (also called hematologic cancers). There were 30,770 new cases of myeloma in the United States in 2018, according to the National Cancer Institute. that 1.8 percent of all new cancers in the United States are associated with myeloma.

The institute states that 52.2 percent of people diagnosed with myeloma in the United States will survive 5 years or more after being diagnosed, while 0.8 percent of men and women in the United States will be diagnosed with myeloma during your lifetime .

Overall, an estimated 124,733 people are living with myeloma in the United States (in 2015).

Global statistics

Multiple myeloma is considered the second most common blood cancer, with approximately 160,000 new cases worldwide each year. Although many new therapies are being developed to treat myeloma, the disease continues to recur and, according to experts, one source causes 106,000 deaths a year worldwide.

Overview

Multiple myeloma is an abnormal growth of plasma cells. This cancer begins in the bone marrow. The immune system is the main system in the body affected by multiple myeloma.

Bone marrow

Bone marrow is a soft, spongy, jelly-like tissue located in the center of the bones. There are two types of bone marrow: red and yellow.

Red bone marrow is mainly found in flat bones such as the hip, ribs, pelvic bones, spine, and humerus; These are the areas most commonly affected by multiple myeloma.

The main function of the bone marrow is to make new blood cells. In fact, it is known to produce up to 200 billion red blood cells every day. The bone marrow produces white blood cells and platelets, which are essential for normal blood clotting.

Plasma cells

Plasma cells are white blood cells produced by the bone marrow. They fight infections in the body by producing antibodies. Normally, the bone marrow has a small number of plasma cells; however, when cancer cells appear in the bone marrow as a result of multiple myeloma, the cancer cells produce abnormal plasma cells. These are called myeloma cells.

The accumulation of myeloma cells can cause localized tumors in the bones called plasmacytomas. In contrast, in multiple myeloma, the accumulation of plasma cells affects the bone marrow of various bones and can adversely affect other healthy immune cells as it interferes with their ability to properly fight infections. In turn, this can lead to a shortage of red blood cells (anemia) as well as a shortage of healthy white blood cells (leukopenia).

Antibodies

An antibody is a protein produced by plasma cells in response to an antigen. Antibodies circulate in the blood and are present in certain secretions (tears, saliva, etc.). Antigens, which can be produced by infectious agents such as bacteria, trigger an immune response. By binding to antigens, the antibodies destroy the cells that carry the antigens on the surface.

The formation of cancer cells in the bone marrow in multiple myeloma can reduce the number of normal producing plasma cells and, in turn, expose the body to infection.

Antigens

An antigen is a molecule that can elicit an immune system response in the body (the immune system response involves the production of antibodies. Antigens are also present on the surface of normal or cancer cells. Myeloma cells can reduce the amount of plasma in the cell and as a result reduces the ability of the immune system to fight antigens because the production of antibodies is suppressed.

Protein M

When malignant plasma cells begin to crowd out normal plasma cells, they suppress the body's ability to fight infection.

Abnormal antibodies called "M protein" (monoclonal protein) are produced by malignant plasma cells. A hallmark of the high level of M protein in the blood, seen in people with multiple myeloma, can cause:

  • Tumors
  • Kidney damage
  • Breaking bones
  • Impaired immune function

Multiple myeloma is considered a "malignant clonal plasma cell tumor." This is because myeloma cells usually start from a single cell that becomes cancerous.

Symptoms of Multiple Myeloma

Common symptoms   multiple myeloma includes:

  • Frequent infections due to a weakened immune system (a person with myeloma is called immunosuppressed)
  • Bone pain (often in the back, ribs, and hips)
  • Kidney problems
  • Weakness from anemia

Causes

The exact cause of multiple myeloma has not been precisely established. It is believed that a genetic factor may be involved due to the higher incidence among close relatives .

Another possible causative factor could be exposure to radiation or contact with chemical solvents such as benzene.

Diagnostics

The diagnosis of multiple myeloma is suspected when an increased amount of certain antibodies is found in the blood and urine. A bone marrow biopsy and bone marrow aspirate (using a biopsy needle and syringe to aspirate a small amount of blood from the bone marrow) are performed to confirm the diagnosis.

Watch out

Treatment for multiple myeloma may include:

  • Traditional chemotherapy drugs such as (melphalan, cyclophosphamide, or bendamustine) that kill cancer cells.
  • Anti-inflammatory drugs that reduce inflammation by preventing white blood cells from moving to areas where myeloma cells are causing damage.
  • Proteasome inhibitors such as bortezomib, carfilzomib, or ixazomib, which kill myeloma cells.
  • Immunomodulatory drugs such as lenalidomide, thalidomide, or pomalidomide, which have strong anticancer properties.
  • Monoclonal antibodies , including daratumumab or elotuzumab, they treat multiple myeloma by targeting antigens to the surface of myeloma cells called CD38. (Monoclonal antibodies are often used for people with myeloma who do not respond to initial treatment, for those who are not eligible for stem cell therapy, or for those who have recurring symptoms after a period of disease remission.)
  • Stem cell transplant that helps replenish normal bone marrow cells after high-dose chemotherapy.
  • Other treatments like pain relievers and radiation therapy for bone pain, etc.
  • Newer agents used to treat multiple myeloma include panobinostat, venetoclax, selinexor, and recently approved belantamab mafodotin. Zoledronic acid and denosumab are often used to prevent bone fractures.

Forecast

According to a report published by the National Cancer Institute, the number of people who have survived in the past 5 years has risen from about 46 percent in 2006 to almost 54 percent in 2016. Of course , some people can vastly outnumber this statistic living far beyond it. five to 10 or even 20 years after diagnosis.

According to a person with multiple myeloma who survived the disease for 11.5 years, the key to longevity is early diagnosis and intervention (before kidney failure occurs), coping effectively with the disease, and seeking the highest level possible care.

Complications

Multiple myeloma can cause many complications, including:

  • Bone fractures (due to plasma cell tumors invading the bone)
  • Hypercalcemia (high calcium levels)
  • Anemia (decreased red blood cell count)
  • Decreased platelet production (prevents blood from clotting normally; symptoms include bleeding or easy bruising)
  • A compromised immune system (leading to various types of infections)
  • Kidney myeloma (monoclonal antibodies build up in the kidneys that can affect kidney function)
  • Kidney stones (due to increased uric acid caused by cancer cell growth)
  • Renal insufficiency
  • Amyloidosis (buildup of proteins called amyloid in the kidneys, liver, and other organs)
  • Other rare complications (for example, high viscosity syndrome due to interruption of normal blood flow, causing blood to thicken)

Front facing

Multiple myeloma generally requires major life changes. Some of these changes may be temporary, while others are long-term. It is important to find a support network and learn how to cope with an ongoing life-threatening illness such as multiple myeloma.

Many survivors recommend having a support pet, attending support group meetings, keeping a journal, and using positive coping mechanisms such as yoga, meditation, mindfulness practice, and more.

When faced with a terminal illness that cannot be cured, some people find it helpful to explore end-of-life options. Issues like pain relief, feeding tube use, and other major medical issues can be proactively addressed long before they arise.

Understandably, most people don't want to focus on mortality from any illness, but learning to be proactive in handling advance directives, living wills, and other end-of-life care issues can be very rewarding.

Get the word of drug information

While researchers are learning more and more about the causes and risk factors of multiple myeloma, much remains to be discovered. If you or a loved one is facing a diagnosis or illness, be sure to reach out to an experienced medical team to discuss your concerns and an outside support group to speak with. These things can be comforting when you are faced with the uncertainty about living with multiple myeloma.

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