Multiple myeloma is a rare, malignant blood cancer that begins silently within the bone marrow, then gradually spreads to affect the bones, kidneys, and the entire immune system. Multiple myeloma affects the plasma cells responsible for producing antibodies that protect the body from infection.
Although the disease was considered one of the most difficult cancers to treat for decades, rapid medical advances in recent years,from modern immunotherapies to advanced stem cell transplants,have completely changed the equation, and have given patients real opportunities for longer, more stable lives. In this article, we take you on a comprehensive journey to understand multiple myeloma,how it begins, what its symptoms are (which may go unnoticed by many in the early stages), how it is accurately diagnosed, and the latest available treatment protocols.
What is multiple myeloma?
Multiple myeloma can be defined as a malignant blood cancer that affects plasma cells in the bone marrow. Plasma cells are a type of white blood cell that live in the spongy tissue of the bone, They originate from B-lymphocytes, and their function is to produce proteins called antibodies that attack and eliminate pathogens.
In multiple myeloma, plasma cells transform into abnormal cancer cells that multiply uncontrollably and accumulate in the bone marrow. and these cells also malfunction, producing an abnormal protein called M protein instead of normal antibodies. The tumor can be classified according to its clinical activity into:
- Latent Stage: At this stage, cancerous plasma cells are present but do not cause any signs or symptoms indicative of a tumor; this condition may progress and develop into active multiple myeloma.
- The Active Stage: At this stage, signs indicative of multiple myeloma appear, and clinical symptoms as well as kidney and bone problems begin.
Causes and risk factors for multiple myeloma:
The main cause of multiple myeloma is not precisely known, and scientists believe that genetic factors play a major role in its development, as mutations lead to the production of abnormal plasma cells that cause cancer, There are also several factors that increase the risk of developing the disease, including:
- Age: The risk of developing multiple myeloma increases with age, and the median age at diagnosis is 65 years.
- Gender: Recent studies have shown that this type of cancer is more common in men than in women.
- Genetic factors: Being related to someone with the disease increases the risk of developing the tumor.
- Monoclonal gammopathy of undetermined significance (MGUS): This is a condition that may precede multiple myeloma, and its presence increases the risk of developing the disease; however, most people with this condition do not go on to develop cancer.
Symptoms of multiple myeloma
Symptoms and clinical manifestations vary depending on the stage of the disease. In multiple myeloma, there is abnormal and uncontrolled proliferation of malignant plasma cells, which accumulate in the bone marrow. These cells play a role in activating osteoclasts and inhibiting osteoblasts, which accelerates bone resorption and leads to numerous bone problems and signs of anemia, in addition to various other symptoms, including:
- Pain in the bones, especially the bones of the back, pelvis, and chest.
- Weak bones that break easily.
- General fatigue.
- Underweight.
- Recurrent infections caused by a weakened immune system.
- Shortness of breath and symptoms caused by anemia.
Symptoms caused by high blood calcium levels
Multiple myeloma causes hypercalcemia due to bone resorption; bones generally serve as the body’s calcium stores, and when they are destroyed, their calcium content is released into the bloodstream, leading to clinical manifestations associated with hypercalcemia, including:
- Nausea.
- Constipation.
- Loss of appetite.
- General weakness.
- Feeling thirsty.
- Frequent urination.
- Neurological symptoms such as mental confusion and impaired thinking.
- Kidney disease may progress to kidney failure.
- Cardiac arrhythmias.
How is multiple myeloma diagnosed?
In some cases, doctors find signs of a tumor through routine blood tests, prompting them to conduct further investigations to detect the disease, The diagnosis of multiple myeloma does not rely on a single diagnostic test; there are several tests that can be performed to establish an accurate diagnosis, including:
- Laboratory blood tests: The abnormal M protein produced by cancerous plasma cells can be detected in routine blood samples, and a blood sample can also be used to measure the concentration of beta-2-microglobulin, which helps determine the stage of the disease. Blood tests also allow for the measurement of calcium levels and the diagnosis of anemia, if present.
- Urinalysis: Urinalysis can detect monoclonal proteins and free monoclonal light chains, also known as Bence Jones proteins.
- Bone Marrow Biopsy: Doctors perform a bone marrow biopsy to confirm the diagnosis and determine the extent of the spread of cancerous plasma cells, as well as to determine the percentage of normal and malignant plasma cells within the bone marrow. as the presence of cancerous plasma cells at a rate exceeding 10% is diagnostic of multiple myeloma, and a higher percentage indicates a more severe form of the disease. The biopsy is performed by removing a sample of spongy bone marrow or aspirating fluid from the bone marrow using a needle inserted into the marrow cavity. The biopsy is most commonly taken from the hip bone, though it can also be taken from other bones. The biopsy is also useful for evaluating the condition of the bone.
- Radiological Tests: Radiological imaging of the bones can provide information about the stage of the disease and its extent in the body. As the disease progresses, small holes or lesions may appear in the bone; these can be detected and their characteristics studied through several radiological tests, including skeletal scans, X-rays, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET).
Stages of multiple myeloma
Doctors use the International Staging System (ISS) to determine the precise stage of cancer. This system is based on measuring the concentrations of beta-2-microglobulin, albumin, and lactate dehydrogenase (LDH) in the blood. The stage of the disease and prognosis vary depending on the concentrations of these compounds, and the stages are classified as follows:
- Stage 1: The beta-2-microglobulin concentration is less than 3.5 milligrams per liter, the albumin concentration is greater than 3.5 grams per deciliter, and lactate dehydrogenase (LDH) levels are within the normal range. At this stage, there are no high-risk cytological changes, and the disease is less severe and has a better prognosis.
- Stage 2: Stage 2 of the disease is diagnosed when the criteria do not match those of Stage 1 or Stage 3; the prognosis is more serious than in Stage 1 but better than in Stage 3.
- Stage 3: The concentration of beta-2-microglobulin is greater than 5.5 milligrams per liter, and the lactate dehydrogenase (LDH) enzyme concentration is higher than normal, along with the presence of high-risk genetic abnormalities; the prognosis is more serious than in the previous stages.
Treatment of multiple myeloma
Accurately establishing the correct diagnosis and clinical stage is of utmost importance in developing an appropriate treatment plan for each patient, as there are many treatment options available; and the success of treatment depends on the stage of the disease, the patient’s condition, and their tolerance for treatment side effects. Upon diagnosis, treatment generally aims to relieve symptoms and pain, manage anemia and hypercalcemia, as well as reducing the number of cancerous plasma cells to the lowest possible level. Treatment options include the following:
- Drug therapy: This may involve a combination of several medications, each of which acts through a different mechanism, including:
- Targeted therapy: This therapy targets proteins and cells that support abnormal plasma cells, thereby weakening and killing these cells. Examples of targeted therapy include proteasome inhibitors and monoclonal antibodies.
- Immunotherapy: This type of treatment helps the body’s immune cells recognize and attack cancer cells. Examples include bispecific antibodies and chimeric antigen receptor T-cell (CAR-T) therapy.
- Chemotherapy: Chemotherapy targets cancer cells and is an important treatment option for multiple myeloma. This type of treatment may be used prior to a bone marrow transplant.
- Stem cell transplant: This is one of the most prominent treatment options for this type of cancer. The transplant is usually autologous (meaning it uses healthy stem cells from the patient themselves), where the patient is given specific medications that stimulate the release of stem cells into the bloodstream, which are then collected using specialized devices, processed, and stored until needed. Afterward, the patient receives high doses of chemotherapy to destroy the cancer cells, and then the stem cells previously collected from the patient are reinfused into the bloodstream via intravenous infusion, Finally, the stem cells settle in the bone marrow and begin their work of producing healthy cells again.
- Radiation Therapy: Radiation therapy uses high-energy beams of specific wavelengths to completely destroy cancer cells. This treatment may be used to relieve bone pain.
Multiple myeloma may recur after treatment, so it is very important to establish a follow-up plan after treatment is completed to detect recurrences early.
Management of complications of multiple myeloma
It is also important during treatment to alleviate symptoms and try to protect the body’s various organs from damage caused by cancer complications. This can be achieved by:
- Bone pain: Certain pain killers, radiation therapy, and, in some cases, surgery may be used.
- Bone loss: Multiple myeloma causes erosion of bone structure, which weakens the bones; this requires the administration of specific medications to protect the bones and reduce the risk of fractures.
- Kidney Damage: If any signs of kidney damage appear, prompt intervention is necessary by treating the underlying cause affecting kidney function; in some severe cases, dialysis may be required.
- Infection: This type of cancer causes a general weakening of the immune system, which strips the body of its defenses and leaves it vulnerable to various diseases, Therefore, it is essential to bridge this gap by administering vaccines and implementing preventive measures to reduce the incidence of infection.
In conclusion, although multiple myeloma is difficult to diagnose, advances in diagnostic and treatment methods have given patients more options and better outcomes in managing the disease, With regular medical follow-up and adherence to an appropriate treatment plan, many patients can continue with their lives and enjoy a good quality of life.
Hope remains as medical research continues and available treatments evolve, so receiving care from a team specializing in hematology and oncology, asking questions, and discussing treatment options can help patients navigate their treatment journey with greater confidence and peace of mind.
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