Myeloma: Diagnosis and Treatment
Did you know that multiple myeloma is the second most common blood cancer, with almost 170,000 new cases diagnosed annually around the world? Yet, many people have not heard of it. Even with medical advancements, the disease is often characterised by recurring relapses, and is incurable for most patients, leading to almost 120,000 deaths every year.
We have learnt about the overall basic understanding of blood cancers, and the diagnosis & treatments of leukaemia and lymphoma. Continue reading to find out more about myeloma diagnosis tests, treatment options, and prognosis.
What is myeloma?
Multiple myeloma is a rare blood cancer which affects the plasma cells – a type of white blood cells in the bone marrow. Plasma cells produce antibodies responsible for fighting infections, and are an important part of the body’s immune system.
The bone marrow is the soft tissue found inside your bones that produces red blood cells, white blood cells, and platelets in addition to plasma cells. Once infected, cancerous plasma cells are also known as multiple myeloma cells. They create abnormal antibodies called M proteins (monoclonal proteins) which are not able to fight infections, resulting in complications.
Like all cancers, multiple myeloma is caused by genetic mutations allowing cells to divide and multiply in a disorganised manner. The growth of cancerous plasma cells in the bone marrow crowds out the normal blood cells and affecting their normal functioning, causing infections, bone and calcium problems, and kidney failure. As the disease worsens, abnormal plasma cells eventually spill out of the bone marrow and spread, causing organ damage.
What are the complications of myeloma?
The shortage of red blood cells leads to anaemia, with patients becoming weak and fatigued. A low platelet count (thrombocytopenia) also leads to increased bleeding and bruising. The shortage of white blood cells (leukopenia) results in an inability to fight infections.
The myeloma cells also crowd out the normal plasma cells, preventing them from producing normal antibodies to fight infections. The myeloma cells themselves do not produce infection-fighting antibodies. As a result, the immune system is susceptible to infections.
Myeloma cells also interfere with cells that keep our bones strong. Osteoclast cells break down old bone while osteoblast cells lay down new bone. Myeloma cells induce osteoclasts, resulting in old bone being broken down without new bone being produced. This make our bones weak and prone to fractures. Increased calcium levels in the blood due to bone breakdown may also lead to extreme thirst, dehydration, constipation, and kidney problems.
Myeloma cells produce incomplete antibodies (light chains) which harm the kidneys, leading to kidney inflammation, damage and even kidney failure. Over 50% of myeloma patients will develop renal impairment during the disease.
How to diagnose myeloma?
The cause of multiple myeloma is unknown, but incidence are higher in males, individuals above 65 years old, have a family history of myeloma, are overweight, or have been exposed to radiation or chemicals found in herbicides or rubber manufacturing. There is evidence that multiple myeloma is growing rapidly in Asia.
Early-stage myeloma patients may not experience any symptoms. Over time, you may experience bone pain, frequent infection, severe thirst, numbness in your limbs, constipation, loss of appetite, and so on.
Multiple myeloma may be accidentally diagnosed during a blood test for other conditions, or if your doctor suspects a myeloma diagnosis based on your symptoms. Your doctor may carry out these procedures to diagnose multiple myeloma:
Doing a lab analysis of your blood may reveal M proteins produced by myeloma cells. If the test detects another abnormal protein produced by myeloma cells (beta-2-microglobulin), this indicates that your myeloma is aggressive. Other blood tests may be done to examine your blood cell count, calcium levels, kidney functions, and uric acid levels.
If your blood has high total protein levels but is low in a protein called albumin, you may be diagnosed as having a globulin gap. Low albumin levels and high serum beta-2-microglobulin is seen in more active and aggressive myeloma.
A urine analysis may reveal M proteins, referred to as Bence Jones proteins when they are detected in urine.
Bone marrow examination
A sample of your bone marrow may be removed for lab testing to examine for myeloma cells. The doctor may conduct a bone marrow biopsy, which involves drawing a small sample using a long needle inserted into a bone. Other specialised tests like fluorescence in situ hybridization (FISH) can be used to analyse myeloma cells to identify gene mutations.
Imaging tests may include MRI, X-ray, CT, or positron emission tomography (PET). These can be done to detect bone problems related to multiple myeloma.
How to treat myeloma?
There’s no cure for multiple myeloma, and the disease recurs in almost every patient. Your doctor will use the test information to assess the aggressiveness of the disease, and classify your disease as stage I, II or III. Stage III indicates the most aggressive stage of disease.
This then helps your doctor understand your prognosis (your survival rate) and treatment options available.
Here are the treatment options for myeloma:
Immunotherapy works by interfering with cancer cells’ ability to produce proteins which enable them to hide from immune system cells. Thus using your immune system to fight cancer.
Bone marrow transplant
Also known as a stem cell transplant, it involves replacing diseased bone marrow with healthy bone marrow. Chemotherapy is first used to destroy diseased bone marrow, followed by an infusion of healthy blood-forming stem cells into your body so that they can rebuild a healthy bone marrow.
Targeted therapy utilises drugs which attack weaknesses or abnormalities within cancer cells, causing them to die.
Chemotherapy treatment involves using drugs to kill cancer cells. There are many different types of chemotherapy drugs.
Corticosteroids are medications which can regulate your immune system to control inflammation and fight against myeloma cells.
Monoclonal antibodies are designed to bind to a myeloma cell’s surface, leading to its death.
Immunomodulatory agents (IMiDs)
These are medications which boost the body’s immune response by activating infection fighting T cells and natural killer cells, hence reducing the growth of and killing myeloma cells.
Proteasomes are structures within cells responsible for breaking down and recycling proteins that are no longer needed. Proteasome inhibitors prevent proteasomes from functioning normally, causing waste to build up, leading to the death of multiple myeloma cells.
This involves using high energy beams from X-rays to kill cancer cells. It can be used to reduce myeloma cells in an affected area, such as a tumour that may be causing pain or destroying a bone.
Stages of treatment
Early-stage myeloma patients may not necessarily need immediate treatment, and will be monitored closely by the doctor. However, since myeloma is well known for recurring cycles of relapse (recurrence) and remission (recovery), patients often need a combination of therapies throughout their treatment journey to manage their condition. Treatment options will depend on your age, overall health, symptoms of relapsed disease, previous treatments, and treatment goals.
The first stage of treatment is referred to as induction therapy, with an aim to reduce multiple myeloma cell count and number of M proteins in the marrow. This treatment phase may include targeted therapy, chemotherapy, and corticosteroids.
Following induction therapy, patients may receive a stem cell transplant to receive healthy stem cells to replace those killed during induction therapy.
Finally, in maintenance therapy, patients continue with a combination of therapies designed to keep them in remission for as long as possible. Remission refers to the disappearance of symptoms and recovery from the disease.
Are there any ways to prevent myeloma? What happens after I’m diagnosed with it?
Some general guidelines for cancer prevention include eating a healthy diet with plenty of fresh fruits and vegetables, limiting your intake of red meat, and lowering your risk by avoiding exposure to radiation and carcinogens.
Unfortunately, there is no cure for myeloma. The overall life expectancy ranges between 1 to 10 years. If you find that you are displaying symptoms of myeloma, do seek expert medical help immediately.
In order to get the best care, it’s important for you to have an open dialogue with your doctor. Be upfront about your feelings, symptoms and lifestyle, so that they can make a complete assessment and tailor a treatment plan that is suited to your individual needs.
Asking your doctor questions can help drive conversations to optimise your treatment, such as:
- Recommended treatments and rationale
- Duration and frequency of treatments
- Side effects and ways to manage or prevent them
- How to identify if the treatment is working or not
- Making changes to your lifestyle to accommodate the treatments
- Understanding all the options available
Keeping your family members in the loop can help to provide emotional support, which is helpful as you undergo your treatment journey. Get in touch with local support groups and be updated on the latest medical advancements on the treatments of multiple myeloma.
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