Multiple Myeloma Treatment in Mumbai, India

Multiple Myeloma is a type of cancer that affects the plasma cells. The plasma cells found in the bone marrow play an important role in the immune system. It is a condition where these cells that make antibodies become cancerous, exhibiting intractable growth, replacing the normal plasma cells.

Associated Anatomy

Bone Marrow

Alternate Name

Kahler's disease or Plasma Cell Myeloma

Multiple Myeloma Symptoms

This type of blood cancer develops symptoms over time and varies from patient to patient. In some cases, there are no symptoms noticed (asymptomatic). The symptoms are:

• Bone pain usually in the lower back or ribs
• An increase in calcium levels in the blood (Hypercalcemia) due to damaged bones that release calcium into the blood. This causes nausea, fatigue, excessive thirst, and abdominal pain.
• Levels of red blood cells go down causing anemia
• Blood platelets and white blood cells also decrease in numbers
• Weakness and numbness in arms and legs
• Hyperviscosity syndrome where the blood becomes thick and blood flow becomes slow due to an increase in the number of m-proteins in the blood
• Cryoglobulinemia is where the levels of abnormal proteins called cryoglobulins increase in the blood which results in joint pain, pain and numbness in fingers and toes, purpura, and weakness
• Amyloidosis happens when a fibrous protein called amyloidosis accumulates in the tissues of the body which may also lead to an organ malfunction.

Multiple Myeloma Causes

The causes of Multiple Myeloma are not known. It is identified that it starts in the bone marrow where the myeloma cells keep multiplying and outnumbering the healthy cells.

Multiple Myeloma Treatment

Physicians and specialists follow certain therapeutic procedures after due consideration of critical factors like cancer stage, symptoms, tumour size, age, among other factors.

• Chemotherapy is a method that uses chemo drugs to reduce the number of myeloma cells facilitating a better response for other treatments.
• Targeted therapies involve consuming medications that target specific proteins, tissues, or genes to stop the growth of cancer cells.
• Immunomodulatory drugs are prescribed to make the patient’s immune system stronger.
• Radiation therapy involves using high-energy X-rays to kill cancerous cells and decrease bone masses.
• Stem-cell transplantation helps the new stem cells behave as parent cells to divide and form different kinds of blood cells such as RBCs, WBCs, and blood platelets.

Multiple Myeloma Risk Factors

There are a few factors that increase the risk of Multiple Myeloma:

• Increased age: The risks of getting this disease increases with age. People above 65 years of age exhibit increased susceptibility.
• Male: Men are more susceptible to this disease than women.
• African American: People who are African American are more likely to get multiple myeloma compared to people of other races.
• UV radiation: Exposure to UV radiation increases the chances of getting multiple myeloma.
• Exposure to chemicals used in the rubber industry also raises the chances of getting the disease.
• Family history of multiple myeloma: If any member of the family has multiple myeloma, then there are high chances of you getting the disease.

Multiple Myeloma Complications

The complications of Multiple Myeloma include:

• Bone complications such as pathologic fractures, hypercalcemia, bone pain, and bone thinning. 
• Infections occur more frequently as the body loses its ability to fight against infections. The count of RBCs, WBCs, and blood platelets decrease in the blood as myeloma cells multiply and increase in number.
•  Decreased kidney function may result in kidney failure.

Multiple Myeloma Prevention

Effective prevention of multiple myeloma is possible, and there are some known preventive measures for the condition. Being mindful of the above-mentioned risk factors and taking steps to prevent or manage them will be helpful in avoiding potential risks.

RISS

The most common system used by doctors to identify this condition is the Revised International Staging System (RISS) which analyses four factors to understand the severity of the condition - albumin levels, lactate dehydrogenase, beta-2 microglobulin, and genetic changes.

Multiple Myeloma Diagnosis

When diagnosing multiple myeloma, a doctor checks for symptoms and then runs the tests like urine or serum protein electrophoresis to confirm the condition. The stage is identified with the help of skeletal radiographs on observation of osteoporosis, lytic lesions, and vertebral compression fractures.

Multiple Myeloma Tests

The tests that are conducted to diagnose multiple myeloma are:

• Complete blood count (CBC) helps measure the levels of RBCs, WBCs, and blood platelets in the blood. The levels of these cells go down in multiple myeloma as myeloma cells increase in number and replace the normal cells.
• Blood chemistry tests measure the levels of calcium, albumin, creatinine, and other electrolytes in the blood. In this disease, the creatinine levels rise, albumin decreases, and calcium levels increase.
• A urine protein electrophoresis test is conducted to check the presence of myeloma protein in the urine.
• Quantitative immunoglobulins test measures the levels of immunoglobulins like IgA, IgD, IgE, IgG, and IgM; in multiple myeloma, the levels of these are found to be fluctuating.
• Beta-2 microglobulin is a protein formed by myeloma cells and hence its presence is tested. High levels of this protein indicate that the disease is in its advanced stage.

Epidemiology

The 3 world regions - Australasia, North America, and Western Europe have the highest ASIR of Multiple Myeloma. It has caused 2.1 million (95% UI, 1.9-2.3 million) DALYs globally in 2016.

Multiple Myeloma Prognosis

The prognosis of the condition is determined by indicators like age, symptoms, and stage. This helps the doctor understand the rate at which the tumour is growing, the extent of disease, response to therapy, and the general health of the patient.

Some patients suffering from multiple myeloma have a life expectancy of about 10 years but the average survival is around 3 years. According to the American Cancer Society, the average survival rate based on the stage of the disease is:

• Stage 1 - 62 months
• Stage 2 - 44 months
• Stage 3 - 29 months

Pathophysiology

There are complex changes in the mechanical, physical, and biochemical functions associated with multiple myeloma. The blood, skeletal, kidney, and neurological processes are affected in this condition.

• It disturbs the process of bone modelling in the body by interfering with the balance between osteoclasts and osteoblasts, the cells that dissolve older bone tissues and replace them with newer ones, respectively. This results in bone fractures and pain in bones.
• When the cancer cells grow uncontrollably, the rate of healthy cells begins to deteriorate causing anaemia, neutropenia, and thrombocytopenia.
• In this condition, the levels of plasma cells increase in the urine causing cell damage, inflammation, and blockage.
• In some multiple myeloma patients, the WBCs enter the central nervous system and cause complications.

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