Multiple myeloma is a plasma cell carcinoma. Plasma cells found in the bone marrow are an important part of the immune system. Your immune system is made up of many types of cells. These cells work together to fight diseases and infections. Lymphocytes are a type of white blood cell. These lymphocytes include B cells and T cells. The bone marrow, intestines, bloodstream, and lymph nodes contain lymphocytes.
Plasma cells produce immunoglobulins (antibody). They help the body attack and kill bacteria. Plasma cells are found primarily in the bone marrow (Soft tissue in bone). Bone marrow contains platelets, white blood cells, and red blood cells along with plasma cells.
Multiple myeloma is when plasma cells become uncontrollable and become cancerous. In multiple myeloma, abnormal plasma cells proliferate rapidly in the bone marrow. Bone marrow is a soft, blood-producing tissue that fills the center of most bones. Cancer cells do not mature and die like normal cells, so they accumulate and ultimately overwhelm the production of healthy cells. Myeloma cells overcrowd healthy cells in the bone marrow, making them unable to fight fatigue and infections.
As healthy plasma cells, myeloma cells also continue to try to produce antibodies. However, myeloma cells produce abnormal antibodies that your body cannot use. Instead, abnormal antibodies (M or monoclonal proteins) accumulate in the body, causing problems such as kidney damage. Cancer cells can also cause damage to bone that increases the risk of fractures.
Causes of myeloma
The exact reason is unknown. Monoclonal immunoglobulinemia was, but not always, a precursor to multiple myeloma. Multiple myeloma is less common than breast, colon, lung, or prostate cancer, but is considered the second most common blood cancer after non-Hodgkin’s lymphoma.
Risk factors for myeloma
- age. Aging is a risk factor. Older people are more prone.This increase in condition is seen in people over the age of 60
- sex.Men are more prone than women
- Race.African Americans Show Incidence Increases
- Genetics. It is a bloodline.If one person is affected, the others in the family are at higher risk
- Environmental cause.Several environmental causes have been identified, but they are not definitive-these factors include radiation exposure, benzene, and pesticides.
Early signs and symptoms:
Early signs and symptoms may or may not be present, but if they are, they may include:
- Increased thirst
- Loss of appetite and weight loss
- Bone pain
- Frequent infections
- Weakness (malaise)
- Weakness and numbness in the arms and legs
The characteristics of multiple myeloma (clear signs and symptoms) include:
a) Low blood cell count
Patients show significantly lower blood cell counts because malignant cells outnumber normal cells. This can also lead to:
- anemia. (Red blood cell deficiency) Makes the patient tired and debilitated.
- Thrombocytopenia. It leads to increased bleeding and bruising (due to lower platelet levels).
- Leukopenia. (Lack of normal white blood cells) increases the risk of infection.
b) Calcium and bone problems
Bones have been consistently remade. This helps keep them strong. Myeloma cells affect the cells that keep bones strong. There are two types of bone cells that keep bones strong and healthy by working together.
- Osteoblasts give birth to new bone.
- Osteoclasts destroy old bone.
Myeloma cells produce substances that indicate that osteoclasts speed up the process of lysing bone. Because of this, old bone is broken down without replacing new bone. This weakens the bones and makes them fragile. People who suffer from myeloma have many cases of fractures. This bone rise in turn collapses, leading to hypercalcemia.
Elevated blood calcium levels are called hypercalcemia. This can lead to the following:
- Bone pain
When the level is high enough, the patient can fall into a coma.
d) Nervous system symptoms
As explained above, bone damage causes spinal cord compression (compression of the spinal nerves when the spinal cord collapses), which causes the following:
- Sudden severe back pain.
- Numbness, numbness in the legs.
- In most cases, leg weakness.
If spinal cord compression is not treated, it can lead to paralysis.
e) High viscosity
Due to the increase in monoclonal proteins in the blood, the blood becomes thicker, slowing blood flow to the brain and can cause the following:
- Stroke and obscure speech.
A process called plasmapheresis can be done to remove proteins from the blood.
f) Kidney problems
Myeloma proteins can damage the kidneys. When your kidneys fail, you lose the ability to remove excess salt, water, and body waste, which can lead to the following symptoms:
- Swelling of the legs.
Multiple myeloma interferes with your body’s ability to fight infections. This can increase the frequency of infection.
Diagnosis of multiple myeloma
Multiple myeloma is often detected by regular blood tests where patients have low blood counts and high total protein levels, but low albumin levels and high calcium levels. Doctors perform physical examinations to detect skin changes such as pallor due to anemia and ecchymosis due to thrombocytopenia, and perform abdominal and neurological examinations to observe tenderness in the bones.
Next, a bone evaluation is performed. This requires a complete radioskeletal bone scan to identify areas of potential fracture or disease infiltration. MRI of the pelvis and spine is done to identify the lesion. A systemic low-dose CT or PET scan may also be needed to identify other bone lesions.
This allows doctors to prescribe further tests to detect monoclonal proteins in blood or 24-hour urine samples by protein electrophoresis. Other tests are then performed, such as immunofixation (to identify the type of monoclonal protein) and tests to measure serum-free light chain levels.
Various blood tests are done, including:
● Complete blood count
● Serum calcium
● Renal function test (urea / creatinine)
● Total protein, S.Albumin, and S. globulin
● Beta 2 microglobulin
● S.LDH (lactase dehydrogenase)
● Cytogenetic examination
Complications of myeloma
- kidney failure. Renal failure is the most common complication associated with myeloma. Twenty-five percent of patients diagnosed with myeloma require long-term dialysis.
- Hematological complications. Malignant cells are more common than normal cells, causing anemia and bleeding disorders.
- Increased infection. As the number of normal WBCs decreases, the incidence of infectious diseases, especially pneumonia, meningitis, and influenza increases.
- Bone complications. Fractures, spinal cord compression, and hypercalcemia.
Staging of multiple myeloma
The lower the stage, the better the prognosis. The international staging system sets guidelines based on serum albumin levels and beta2 microglobulin levels.
- Stage 1: Serum Beta 2 Microglobulin<3.5mg / dlおよび血清アルブミン> / = 3.5g / dl.
- Stage 2: Not Stage 1 or 3.
- Stage 3: Serum beta 2 microglobulin> / = 5.5 mg / l.
Recurrent or recurrent myeloma
Myeloma that recurs after being placed under control after treatment is known as recurrent myeloma or recurrent myeloma. If the myeloma recurs, the cancer needs to be staged again. This is called restaging.
Management of myeloma
Treatment should be started as soon as possible to prevent damage to the organs.
The standard treatment options are:
- Targeted therapy. Drugs such as bortezomib, carfilzomib, and ixazomib block the action of substances in myeloma cells that break down proteins. This kills myeloma cells.
- Biological therapy. Drugs such as thalidomide, lenalidomide, and pomalidomide are prescribed to strengthen the body’s immune system to identify malignant cells and kill them.
- chemical treatment. The drug kills fast-growing cells. High doses of chemotherapeutic drugs are used before bone marrow transplantation.
- Corticosteroids. Prednisolone and dexamethasone regulate the immune system to control inflammation in the body.
- Bone marrow transplantation. Also known as a stem cell transplant, this is a procedure that replaces diseased bone marrow with healthy bone marrow.
- Radiation therapy. It is used to kill myeloma cells and stop their growth.
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Side effects of treatment
● Loss of appetite. Try to eat fewer meals more often to combat this problem.
● Constipation. This is generally drug-induced. Laxatives can be used.
● Hair loss.
Frequently Asked Questions (FAQ)
- Can myeloma be prevented?
The cause is unknown, so preventive measures are unknown.
- Will Multiple Myeloma Cure?
Currently, there is no permanent cure for myeloma. It can only be managed by stem cell therapy or other means.
- What is your life expectancy?
From the time of diagnosis, a period of 5 to 8 years is expected, depending on the severity of the symptoms and the stage of myeloma.
read more : Understanding the Most Common Myeloma: Multiple Myeloma