What is multiple myeloma?
Multiple myeloma (also simply called myeloma) is a rare type of blood cancer that develops in bones and other areas of the body. Myeloma cells release large amounts of myeloma proteins, which can impair bodily functions (like kidney function). Myeloma cells can also destroy bone tissue, causing high calcium levels, bone pain, weakened bones, and bone fractures. Myeloma cells can form tumors called plasmacytomas. Rarely, some people develop only one tumor, which is called solitary plasmacytoma. More often, people may have multiple plasmacytomas in different bones or areas of the body. Older age (age 65 and over) greatly increases the risk of developing multiple myeloma. It’s also more common in men than in women, and two to three times more common in first-degree relatives.
What causes multiple myeloma?
Many people wonder why they got cancer. Doctors don’t know exactly what causes cancerous myeloma cells to form. What doctors do know is that myelomas and other cancers often start with abnormalities (mutations) in the cells, which allow the cells to grow unchecked. These types of mutations aren’t typically passed down in families (hereditary mutation). They happen on their own and only in tumor cells. Still, you may have a higher risk for myeloma if another family member also had myeloma. The mutation occurs in the cells’ genes. Genes carry the “instructions” in cells for making new cells and for controlling how cells behave. A gene mutation can turn helpful, normal plasma cells into harmful, cancerous myeloma cells. What are plasma cells? Plasma cells come from white blood cells called B cells, a type of immune cell. Plasma cells fight infection and disease. They do this by making antibodies (also called immunoglobulins [Ig]). Antibodies are proteins released into blood and other body fluids that help your body find and kill germs. Like other healthy cells, plasma cells grow and then divide to make new cells. New cells are made as the body needs them. When plasma cells grow old or get damaged, they die—a normal and natural process. But somewhere along the line, genetic alterations occur that turn a plasma cell into a myeloma cell. Myeloma cells, unlike healthy plasma cells, make more and more new myeloma cells that aren’t needed and don’t die quickly when old or damaged. The myeloma cells continue to make millions of identical copies of themselves. They can spread throughout the bone marrow or grow into a clump (mass) in one or more spots outside of the bone marrow. These masses can destroy the bone around them as they grow. Myeloma cells, like normal plasma cells, also make antibodies. But the antibodies made by myeloma cells are all copies of a single type of antibody. These are called monoclonal proteins, M-proteins, or M-spike. Myeloma cells make M-proteins without control and not in response to a specific germ in the body. M-proteins don’t help to fight infections.
Types of myeloma?
There are two basic types of myeloma: Symptomatic (active) and smoldering.
Symptomatic (or active) myeloma causes symptoms or affects organs. Common symptoms include bone pain, frequent infections, fatigue, and more. Myeloma that’s causing symptoms should be treated. Symptoms, though, aren’t the only signal for treating myeloma. Results from certain lab tests also show when it’s time to start treatment. These tests can identify when someone has a high level of M-protein in the bone marrow, as well as kidney problems, bone lesions, too much calcium or too few red blood cells in the bloodstream, and other signs of myeloma.
When myeloma isn’t causing symptoms and doesn’t require immediate treatment, it’s called smoldering myeloma. People with smoldering myeloma have M-protein in blood and plasma cells in the bone marrow, but usually at lower levels than people with multiple myeloma. People with smoldering myeloma don’t need to be treated, but they are tested regularly for signs of multiple myeloma. Smoldering myeloma sometimes turns into multiple myeloma. But smoldering myeloma can exist for years before becoming multiple myeloma.
There’s no single recommended treatment for multiple myeloma—there are many treatment options. You and your doctors will work together to figure out the best treatment for you.
Most people with myeloma receive a combination of several treatments. However, no one with myeloma will receive every treatment. Standard treatment for multiple myeloma often involves a combination of three medicines (sometimes called triplet therapy). For example: VCD or VRD treatment.
- a proteasome inhibitor: velcade or carfilzomib
- an immunotherapy drug: cyclophosphamide or lenalidomide
- a corticosteroid: dexamethasone
These aren’t the only treatments for multiple myeloma, though. For example, a chemotherapy drug may be used in place of the immunotherapy drug. Also, the three-drug treatment may be followed by a stem cell transplant or another therapy. Some people receive a four-drug treatment. Usually Daratumumab (anti CD 38 antibody) is added as a fourth drug.
Radiation therapy is used as the treatment for a solitary plasmacytoma (a single mass of myeloma cells). Radiation therapy involves a large machine that sends out high-energy rays to a specific area. The rays damage the genes in cancer cells. This either kills the cancer cells or stops new cancer cells from being made. Radiation therapy usually requires a series of treatments over several days or weeks.
Surgery is rarely used to treat multiple myeloma, but it may be used to fix fractures in bones or stabilize the spinal cord due to myeloma.
Stem cell transplant (Bone marrow transplant)
Cancer and its treatment—especially when used in high doses—can damage and destroy cells in the bone marrow. A stem cell transplant replaces the damaged or destroyed cells with healthy stem cells. This is also called a stem cell rescue or a bone marrow transplant. (It’s not a transplant surgery like a heart or lung transplant because the rescue cells are given through an IV infusion. A stem cell transplant uses powerful chemotherapy to destroy the cancerous cells in your bone marrow. These are restored with healthy blood stem cells, which grow new blood cells and bone marrow over time. Blood stem cells can develop into all types of mature blood cells. There are two main types of stem cell transplants. An autologous stem cell transplant uses your own blood stem cells to regrow bone marrow. An allogeneic stem cell transplant uses blood stem cells that come from another person (donor).
Autologous stem cell transplants are a common treatment for multiple myeloma, but they’re not for everyone. A stem cell transplant is an intense treatment. Doctors consider many factors when deciding who will benefit from this procedure. Some of these factors include your fitness level, health status, vital organ function, cancer stage, previous treatments, other medical conditions, available supportive care, and additional factors.
Myeloma remission period prolongs 2 or 3 times more with Autologous stem cell transplant and that treatment is tried to be offer every patient as a standard.