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Myeloma

myeloma


Myeloma is a cancer of certain white blood cells called plasma cells. The cancerous plasma cells build up in the bone marrow. They also make a lot of one type of antibody. As a result, various symptoms develop.

What are the bone marrow, plasma cells and antibodies?

The bone marrow is the soft sponge-like material in the centre of bones. The bone marrow is where blood cells are made by stem cells. Stem cells are the immature cells that can develop into mature blood cells. Stem cells constantly divide and produce new cells. Some new cells remain as stem cells, and others go through a series of maturing stages (precursor or blast cells) before forming into mature blood cells. The blood cells made by stem cells are red blood cells, white blood cells and platelets.

Plasma cells are one type of white blood cell. White blood cells are a main part of the immune system, defending the body from infection. There are various types of white blood cells including plasma cells.

Antibodies (immunoglobulins) are made by plasma cells. Antibodies are proteins that attach to, and help destroy germs such as bacteria and viruses. Normally, plasma cells make many different antibodies, each able to attack different bacteria and viruses.

What happens in myeloma?

As with other cancers, what seems to happen is that the cancer starts with one abnormal cell. In the case of myeloma, one plasma cell at first becomes cancerous. This abnormal cell then multiplies to produce many identical abnormal plasma cells (a clone of cells). The cancerous plasma cells mainly collect in the bone marrow and continue to multiply without any control. In the majority of cases of myeloma, the abnormal plasma cells make large quantities of one antibody. This single type of antibody is called a paraprotein.

There are several different types of antibody. These are called IgM, IgG, IgA, IgD and IgE. Myelomas are sub-classified by the type of antibody that they make. For example, IgG myeloma is the most common type.

What causes myeloma?

It is not known why a plasma cell becomes cancerous. Factors such as infection, or chemicals, or other environmental factors may play a part in damaging cells and causing cancers such as myeloma.

How common is myeloma and who does it affect?

Myeloma is uncommon. Most cases occur in people over the age of 50, and it becomes more common with increasing age. The average age of diagnosis is 70. Men are affected more often than women.

What are the symptoms and problems with myeloma?

There may be no symptoms at first in the early stages of the disease.

Bone damage and related problems

The increasing numbers of plasma cells in the bone marrow act like growing tumours (plasmacytomas) inside the bones. They also make a chemical that can damage bone. In time, small parts of bone are destroyed and are called lytic lesions.

The damage to bone can cause:

  • Bone pain.
  • Fractures.
  • Compression of nerves coming out of the spinal cord.
  • Hypercalcaemia. This means a high level of calcium in the blood (due to the bone breaking down).
  • Anaemia.

Blood clotting problems.

Serious infections.

Kidney damage

Hyperviscosity

This means that the blood may become too thick due to a very high level of paraprotein. Symptoms include problems such as bruising, nose bleeds, hazy vision, headaches, sleepiness and various other symptoms.

Amyloidosis: This is an uncommon complication of myeloma. This is a condition where abnormal protein (amyloid) accumulates in various parts of the body. It can cause various symptoms.

How is myeloma diagnosed?

Tests commonly done to confirm the diagnosis of myeloma include:

  • A blood or urine test to detect the paraprotein.
  • A bone marrow sample.
  • X-rays of bones.
  • MRI, CT or ultrasound scans may be done if X-ray tests do not give enough detailed information.

Other tests which are commonly done to assess the severity of the disease and to monitor the response to treatment include:

  • Blood tests to check on your kidney function.
  • Blood tests to check the level of calcium in your blood.
  • Blood tests to check the level of paraprotein in your blood.
  • Chromosome and gene testing of the myeloma cells.
  • Blood tests to measure proteins in the blood, called beta-2 microglobulin and albumin. The levels of these proteins are affected by myeloma and give an indication as to the severity of the disease.

What are the aims of the treatment for myeloma?

Treatments may be used to treat and to control the myeloma itself; also, to ease symptoms and complications of the myeloma. Treatment is usually given to those people with myeloma who have some organ or tissue damage due to the myeloma. Treatment is not usually started in those people who have no symptoms from their myeloma. However, these people are normally monitored closely by a specialist as there is a chance that treatment may be needed in the future.

Treatments to control the myeloma

In many cases, treatment can control the myeloma and put the disease into remission. Remission is not necessarily a cure. Full remission means that tests cannot detect the abnormal plasma cells in the blood or bone marrow, and the bone marrow is producing normal blood cells again.

Chemotherapy

Chemotherapy is a treatment which uses anticancer drugs to kill cancer (myeloma) cells, or to stop them from multiplying. Various drugs are used and myeloma may be treated with chemotherapy drugs given as tablets or injections. The exact combination of drugs used, and the length of the course of chemotherapy, depends on various factors.

If a course of chemotherapy achieves a remission, you may then be advised to take drugs as a regular maintenance treatment. These may include interferon, steroids, thalidomide, lenalidomide or bortezomib.

Stem cell transplant

A stem cell transplant may be an option. It is an intensive treatment that is not suitable in all cases. However, this treatment generally gives the best chance of a complete remission.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. For myeloma, radiotherapy is mainly used to treat severe localised problems and plasmacytomas. For example, to treat severe pain and/or pressure on nerves due to a damaged spinal bone because of a build-up of myeloma cells in the bone.

Treatments to ease symptoms

Painkillers

Bisphosphonates are a type of medicine that is used to strengthen your bones. It is now recommended that all people with myeloma that is causing any symptoms should take a bisphosphonate.

Erythropoietin. This is a hormone that helps to increase the number of red cells made in the bone marrow. It may be used to help improve anaemia.

Blood transfusions to correct anaemia.

Plasma exchange or exchange blood transfusions if you have a very high level of paraprotein in your blood, which is causing hyperviscosity symptoms.

Antibiotics if you develop infections.

Surgery is sometimes needed to help heal fractured bones or to ease pressure on a trapped nerve due to fractures of the spinal bones.

Kidney dialysis if you develop kidney damage and kidney failure.

People with myeloma will also usually be advised to drink plenty of fluids (at least three litres a day). This helps to lower a high calcium level.

What is the prognosis (outlook)?

In general, with treatment, about half of people with myeloma are alive and well 3-4 years after diagnosis. In some cases the disease responds very well to treatment and survival is much longer. In particular, a successful stem cell transplant gives a good chance of a complete remission. In some cases the disease does not respond to treatment very well, or life-threatening complications develop such as kidney failure.


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