Multiple myeloma

What is multiple myeloma?

    Multiple myeloma, also referred to as Kahler's disease, represents a form of blood cancer. While currently lacking a cure, various treatments exist to slow its progression and alleviate symptoms.

    In multiple myeloma, a type of white blood cell known as plasma cells undergoes abnormal multiplication. These cells produce excessive amounts of protein, specifically immunoglobulin, accumulating in the bones and bloodstream, leading to organ damage.

    The proliferation of plasma cells disrupts the production of normal blood cells in the bone marrow and prompts the release of chemicals that stimulate bone-degrading cells. Consequently, weakened areas known as lytic lesions form in the bones.

    As the disease advances, plasma cells escape from the bone marrow and disseminate, causing further harm to organs and exacerbating the condition.

What are the causes of multiple myeloma?

    The precise cause of multiple myeloma remains uncertain. Still, several factors may increase the likelihood of developing the condition, including:

  • Advanced age, mainly being older than 65
  • Male gender
  • African American ethnicity
  • Family history of multiple myeloma
  • Being overweight or obese
  • Exposure to radiation
  • Occupational exposure to chemicals found in rubber manufacturing, woodworking, firefighting, or herbicides

What are the symptoms of multiple myeloma?

    In the early stages of multiple myeloma, individuals may not experience any symptoms. However, when signs and symptoms manifest, they can encompass:

    1. Bone pain, particularly affecting the spine, chest, or hips.

    2. Nausea.

    3. Constipation.

    4. Loss of appetite.

    5. Mental fog or confusion.

    6. Fatigue.

    7. Increased susceptibility to infections.

    8. Weight loss.

    9. Weakness.

    10. Excessive thirst.

    11. Frequent urination.

What are the complications of multiple myeloma?

    Complications associated with multiple myeloma comprise:

    1. Infections: Multiple myeloma diminishes the body's capacity to combat infections effectively.

    2. Bone complications: This condition can induce bone pain, bone thinning, and fractures.

    3. Kidney issues: Multiple myeloma may impair kidney function, potentially culminating in kidney failure.

    4. Anemia: Myeloma cells outnumber healthy blood cells, leading to a low red blood cell count, which can result in anemia and other blood-related complications.

What is the diagnosis of multiple myeloma?

    Your healthcare provider may suspect multiple myeloma if incidental findings from blood tests reveal:

  • Elevated calcium levels in the blood (hypercalcemia)
  • Decreased red blood cell count (anemia)
  • Impaired kidney function
  • Elevated total protein levels in the blood, coupled with decreased levels of a specific protein called albumin (termed a "globulin gap" by your doctor)

    To confirm the diagnosis, additional blood tests may be conducted, including:

    1. A complete blood count (CBC), which assesses various types of blood cells.

    2. Blood urea nitrogen (BUN) and creatinine tests to evaluate kidney function.

    Further blood and urine analyses assess if your body produces abnormal proteins, their types, and their quantities.

    Your healthcare provider may recommend a bone marrow biopsy following the blood and urine test results. During this procedure, a needle is inserted into a bone, typically the hip, to obtain a sample of bone marrow. This sample is examined to determine the presence and quantity of plasma cells.

    Imaging studies may also be ordered. X-rays can reveal areas of bone affected by multiple myeloma. Additionally, your doctor may recommend a CT scan, MRI, or PET scan for further evaluation.

What are the treatments for multiple myeloma?

    Treatment for multiple myeloma may not be immediately necessary, especially if no symptoms are present. In such cases, a watch-and-wait approach may be adopted to monitor the progression of the disease. However, when symptoms arise, treatment typically begins with medication aimed at relieving pain, managing complications, and slowing the growth of myeloma cells.

    Sometimes, multiple myeloma is asymptomatic, referred to as smouldering multiple myeloma. In such instances, immediate treatment may not be required. Instead, regular checkups are conducted to monitor the cancer's progression. Blood and urine tests are performed periodically to detect signs of worsening myeloma.

    Treatment options for multiple myeloma may include:

    1. Targeted therapy: This approach utilizes medications that target specific chemicals within cancer cells, inducing their death.

    2. Immunotherapy: Immunotherapy employs medications to enhance the body's immune system, enabling it to identify and eliminate cancer cells.

    3. CAR-T cell therapy: Chimeric antigen receptor T cell therapy involves modifying immune system cells, such as T cells, in a lab to recognize and destroy myeloma cells.

    4. Chemotherapy: Chemotherapy utilizes potent drugs to kill fast-growing cancer cells, including myeloma cells.

    5. Corticosteroids: These medications help alleviate inflammation and swelling in the body and can also target myeloma cells.

    6. Bone marrow transplant: Also known as a stem cell transplant, this procedure involves replacing diseased bone marrow with healthy marrow. Stem cells may be obtained from the patient (autologous transplant) or a healthy donor (allogeneic transplant).

    7. Radiation therapy: Radiation therapy employs high-energy beams to target and destroy cancer cells, which is particularly useful for shrinking myeloma cell masses or controlling plasmacytomas that cause pain or bone destruction.

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