Plasma cells are a part of the bone marrow and are an essential part of the immune system. They bind together to fight against any infections in the body. One of the essential types of White Blood Corpuscles includes lymphocytes that contain the B cells and the T cells; they are found in lymph nodes, bone marrow and bloodstream.
The B cells respond to an infection; they turn into plasma cells. The plasma cells develop in the bone marrow and help the body against germs. Bone marrow is also a production site for other cells like red blood cells, white blood cells and platelets.
Multiple myeloma is when the plasma cells grow out of control and become cancerous. It can sometimes be mistaken for other plasma cell disorders like:
- Solitary plasmacytoma
- Light chain amyloidosis
- Smouldering multiple myeloma
- Monoclonal gammopathy
Types
Types of multiple myeloma include:
1. Asymptomatic myeloma:
In this type, the person does not show any signs and symptoms of the disease. Asymptotic patients have to be watched closely. This is called active surveillance of myelomas.
2. Symptomatic myeloma:
When the person experiences symptoms of the disease, they tend to need treatment.
Stages
Staging of multiple myeloma can be done by various techniques. Two techniques include:
• Durie- Salmon Staging
This staging classifies myeloma in three stages: Stage I, Stage II, and Stage III.
This depends on:
- The number of myeloma cells in the body.
- Bone damage caused due to the cells.
- M-protein levels in blood and urine.
- Blood calcium levels
- Hb and Albumin levels.
The kidney damage also classifies myelomas into Group A or Group B. Group A usually denotes normal functioning and Group B as abnormal kidney functioning. For instance, a person might be classified as Stage IIB.
International Staging System:
The albumin level (> or < than 3.5 mg/dL) and microglobulin level (< 3.5, 3.5 to 5, or > 5 mg/L) denote the staging in this system. The higher the stage, the poorer the outcome.
Symptoms
Multiple myeloma usually does not show any symptoms in the early stages. The only diagnosis comes from routine testing of blood or urine.
The following are common symptoms:
- Tenderness in the bones
- Achy bones
- Bones that are usually not strong and may fracture easily
- Weakness, shortness of breath and tiredness
- Repeated infections due to low immunity
- Kidney problems
- Rarely, multiple myeloma may cause bruising and bleeding
Causes And Risk Factors
Causes
There is no exact cause of multiple myeloma. Symptoms are a result of abnormal multiplication of plasma cells in the bone marrow. Studies show numerous myelomas can be a result of genetic abnormalities or environmental factors like radiation exposure.
Myeloma cells are also found to have missing parts of chromosome 13.
Risk Factors
The risk factors for developing multiple myeloma are:
- More prevalent in men
- Multiple myeloma is more common in adults above 60 years; rarely, do people below 40 get affected.
- It is more commonly found in black populations rather than Asian or white populations.
- Family history.
Prevention
Risk factors for most cancers are known to us, e.g. smoking causes lung cancer; this helps us prevent cancer. In the case of multiple myeloma, there are risk factors that you cannot avoid. Multiple myeloma is developed in people with monoclonal gammopathy of undetermined significance, which you cannot prevent. Researchers are looking to find ways to treat smouldering myeloma to prevent them from developing into multiple active myelomas.
Diagnosis
- Multiple myelomas are usually diagnosed late because they are uncommon and have very few or no symptoms in the early stages.
- When you visit the physician, he will enquire about the signs and symptoms you are facing, evaluate your medical history and examine your overall health.
- Urine and blood tests are used to check for the presence of antibodies and proteins. Serum protein electrophoresis is done to note the presence of a specific protein band related to multiple myeloma.
- X-Ray of your arms, pelvis, legs and skull are taken to check for any damage. You might also be suggested to take CT Scan and MRI.
- Bone marrow biopsy is an essential test to confirm the diagnosis of multiple myelomas. This procedure is carried out by taking a small sample of bone marrow using a needle.
Treatment
The treatment of multiple myelomas depends upon the severity of the condition. People with asymptotic multiple myeloma do not need treatment but strict monitoring. If you have asymptomatic multiple myeloma, your doctor might monitor the progression and then develop a plan to treat the cancer.
For patients with symptomatic multiple myeloma, treatment includes a combination of various medications. The medications work on destroy cancerous cells, decrease the rate of infection and provide pain relief. The treatment may include:
Medications that work on destroying the cancer cells:
- Chemotherapy drugs, HDAC inhibitors and Proteasome inhibitors are the drugs that help to kill the cancer cells and avoid multiplication. These drugs are available in the form of pills or injections.
- Immunotherapy drugs: These drugs boost your immune system and help fight cancerous cells.
- Steroids: Steroid is used to reduce inflammation.
- Antibiotics: Antibiotics help prevent infections as the immune system has been weakened.
- Radiation therapy: The radiation targets tumours with high-energy X-rays.
- Stem cell transplant: Some patients need to use stem cell transplant. In this process, the patient’s stem cells, which were collected beforehand, are infused back into the body. This helps the bone marrow to recover and become stronger.
Lifestyle/management
Lifestyle changes do not directly affect multiple myeloma, but they can help improve the overall health of the body. They can help to:
- Manage and lessen the incidence of side effects.
- Keep the immune system strong and prevent infections.
- Improve the emotional effects.
- Lower the risk factors that might lead to complications.
The lifestyle changes recommended are:
- Quit smoking: Smoking may slow the healing process and also affect your immune system negatively. Quitting smoking is one step toward adopting a healthy lifestyle.
- Reduce the risk of developing infections: Multiple myeloma affects the body’s immunity, making it prone to infections.
You can:
- Wash your hands frequently and sanitise them. This helps you to get rid of bacteria and germs.
- Avoid crowded places.
- Clean daily objects with disinfectants.
- Make sure your vaccination is up to date.
- Make changes in your diet
A healthy diet maintains the stability of your body as well as your mind. Healthy food will help your body to function well and give you energy. Proper nutrition helps with recovery and healing. The treatment of multiple myeloma may affect your appetite; keep a watch on your food intake and consult a dietitian to prevent weight loss.
Regular exercise
Regular exercise helps boost the immune system and keep a steady weight. It helps with boosting your energy level and improves your mental health. You can take the help of a trainer.
Fatigue management
Treatment may make you feel fatigued quickly. Allow your near and dear ones to help you with chores and plan accordingly.
Prevent falling
Weak bones are a result of multiple myelomas; this can result in fractures. You can prevent this by:
- Using support devices like walkers.
- Keeping a watch on tripping over rugs, cords and wires.
- Make your rooms brighter.
- Asking for help from near and dear ones.
Seeking support
It is overwhelming to worry and think about treatment and changes. Try to keep your emotional balance by
- joining support groups.
- gaining support from social workers, psychologists or psychiatrists.
- seeking comfort from family members.
Prognosis And Complications
Prognosis
There are many promising therapies available for the treatment of multiple myeloma. Progress can be controlled via therapy. The survival rate is also high in patients with multiple myelomas. Treatments improve the life span by 5-10 years.
Complications
Complications of multiple myeloma:
- Bone problems: Weak bones that lead to complicated fractures.
- Increased risk of infections: Weak immunity causes the occurrence of diseases.
- Kidney problems: Multiple myeloma affects the kidneys' ability to filter out toxins from the body, leading to kidney failure.
- Anaemia: Low count of red blood cells causes anaemia.
- Hypercalcemia: Destruction of bones causes too much calcium to be present in the blood, leading to hypercalcemia.
- Amyloidosis.
References.
- Cancer.org. What is multiple myeloma? [Internet] [Updated on: 28 February, 2018] Available at: https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html Accessed on: 8th April, 2021.
- Cancer.net. Multiple myeloma- Stages. [Internet] [Updated on: 05/2020] Available at: https://www.cancer.net/cancer-types/multiple-myeloma/stages
- University of Iowa and Clinics. Multiple myeloma stages and types. [Internet] [Updated on: November 2015] Available at: https://uihc.org/health-topics/multiple-myeloma-stages-and-types
- National Health Services. Multiple Myeloma. [Internet] [Updated on: 11 April, 2018] Available at: https://www.nhs.uk/conditions/multiple-myeloma/
- Rare Diseases. Multiple Myeloma. [Internet] [Updated on: 2019] Available at: https://rarediseases.org/rare-diseases/multiple-myeloma/
- Cancer.org. Multiple myeloma- Prevention. [Internet] [Updated on: 28 February, 2018] Available at: https://www.cancer.org/cancer/multiple-myeloma/causes-risks-prevention/prevention.html
- National Health Services. Multiple myeloma- Diagnosis. [Internet] [Updated on: 1st Aug, 2019] Available at: https://www.nhs.uk/conditions/multiple-myeloma/diagnosis/
- Cleveland Clinic. Multiple myeloma. [Internet] [Updated on: 16th July, 2020] Available at: https://my.clevelandclinic.org/health/articles/6178-multiple-myeloma
- Winchester Hospital. Lifestyle changes to Manage Multiple Myeloma. [Internet] [Updated on: May 2019] Available at: https://www.winchesterhospital.org/health-library/article?id=32740
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