Multiple myeloma

What is multiple myeloma?

Multiple myeloma is a plasma cell malignancy. The immune system relies on normal plasma cells, which are present in the bone marrow. The immune system is made up of various cell types that collaborate to fight infections and other disorders. T cells and B cells are examples of lymphocytes (lymph cells), which are one of the main types of white blood cells in the immune system. Lymphocytes can be found in a variety of places throughout the body, including lymph nodes, bone marrow, the intestines, and the circulation.

B cells mature and transform into plasma cells in response to infection. Antibodies (also known as immunoglobulins) are produced by plasma cells and help the body attack and eliminate infections. Plasma cells are primarily present in bone marrow. The soft tissue inside bones is called bone marrow. Other blood cells, such as red cells, white cells, and platelets, live in normal bone marrow in addition to plasma cells.

Multiple myeloma is a condition in which plasma cells become malignant and expand out of control. Monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike, or paraprotein are all names for an aberrant protein (antibody) produced by plasma cells.

Other plasma cell illnesses, on the other hand, have aberrant plasma cells but do not meet the criteria for being classified as active multiple myeloma. The following are some of the other plasma cell disorders:

• Monoclonal gammopathy of uncertain significance (MGUS)
• Smoldering multiple myeloma (SMM)
• Solitary plasmacytoma
• Light chain amyloidosis.

Symptoms of multiple myeloma

Signs and symptoms of multiple myeloma can vary and, early in the disease, there may be none.

When signs and symptoms do occur, they can include:

• Bone pain, especially in your spine or chest
• Nausea
• Constipation
• Loss of appetite
• Mental fogginess or confusion
• Fatigue
• Frequent infections
• Weight loss
• Weakness or numbness in your legs
• Excessive thirst

Causes of multiple myeloma

It is unknown what causes myeloma. Myeloma is thought to start with a single aberrant plasma cell in your bone marrow, which is the soft, blood-producing tissue that fills the middle of most of your bones. The aberrant cell proliferates quickly.

Because cancer cells do not mature and subsequently die like regular cells, they collect and eventually outnumber healthy cell creation. Myeloma cells squeeze out healthy blood cells in the bone marrow, causing exhaustion and an inability to fight infections.

Myeloma cells, like healthy plasma cells, continue to try to make antibodies, but they produce aberrant antibodies that the body can’t employ. Instead, aberrant antibodies (monoclonal proteins, or M proteins) accumulate in the body, causing issues such as kidney damage. Cancer cells can also cause bone deterioration, increasing the chance of breaking a bone.

A connection with MGUS

Multiple myeloma almost always starts out as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS).

MGUS, like multiple myeloma, is marked by the presence of M proteins — produced by abnormal plasma cells — in your blood. However, in MGUS, the levels of M proteins are lower and no damage to the body occurs.

Risk factors

Factors that may increase your risk of multiple myeloma include:

• Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-60s.
• Male sex. Men are more likely to develop the disease than are women.
• Black race. Black people are more likely to develop multiple myeloma than are people of other races.
• Family history of multiple myeloma. If a brother, sister or parent has multiple myeloma, you have an increased risk of the disease.
• Personal history of a monoclonal gammopathy of undetermined significance (MGUS). Multiple myeloma almost always starts out as MGUS, so having this condition increases your risk.

Complications in multiple myeloma

Complications of multiple myeloma include:

• Frequent infections. Myeloma cells inhibit your body’s ability to fight infections.
• Bone problems. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones and broken bones.
• Reduced kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure.
• Low red blood cell count (anemia). As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.

Diagnosis of multiple myeloma 

When your doctor detects multiple myeloma by accident during a blood test for another ailment, it is called multiple myeloma. If your doctor suspects you have multiple myeloma based on your signs and symptoms, it can be diagnosed.

Tests and procedures used to diagnose multiple myeloma include:

• Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.

  Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.

• Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.

• Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).

  In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to identify gene mutations.

• Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).

Treatment of multiple myeloma

Treatment can help reduce pain, control illness complications, stabilise your condition, and limit the progression of multiple myeloma if you’re suffering symptoms.

Treatments for myeloma

Standard treatment options include:

• Targeted therapy. Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
• Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
• Chemotherapy. Chemotherapy uses drugs to kill cancer cells. The drugs kill fast-growing cells, including myeloma cells. High doses of chemotherapy drugs are used before a bone marrow transplant.
• Corticosteroids. Corticosteroid medications regulate the immune system to control inflammation in the body. They are also active against myeloma cells.

• Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.

  Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.

• Radiation therapy. Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. It may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that’s causing pain or destroying a bone.
• CAR T-cell therapy: CAR T-cell treatment, a sort of immunotherapy, is now available for certain people with multiple myeloma. The Food and Drug Administration (FDA) approved idecabtagene vicleucel (Abecma) on March 26 for persons who have multiple myeloma that has not responded or relapsed after at least four previous cancer therapies. 

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