Multiple Myeloma: Information on Causes, Diagnosis & Treatments
Multiple myeloma is a blood-associated cancer related to leukemia and lymphoma. Even though scientists and doctors have no cure for the disease, treatments are available that can slow down its progression to spread. Multiple myeloma occurs when plasma cells in the bloodstream multiply abnormally. Instead of developing antibodies to protect the body against infections, they instead release excessive levels of immunoglobulin into the blood and bones. Excessive levels of immunoglobulin in the body can damage organs.
In addition, the abnormal growing plasma cells crowd healthy blood cells in the bones and dissolve the bone tissue by releasing chemicals. The weakened bone tissue creates lytic lesions. As the condition worsens the plasma cell start spilling out from the marrow inside the bone and spreads (metastasizes) to distant body sites, causing more damage to organs.
- Who Is at Risk for Multiple Myeloma?
- Multiple Myeloma Causes
- Common Symptoms
- Diagnosing the Condition
- Treating Multiple Myeloma
Who Is at Risk for Multiple Myeloma?
While anyone can develop multiple myeloma, there are certain risk factors that increase the potential chances of developing the condition. The known multiple myeloma risk factors include:
- Growing Older – The risk of developing multiple myeloma increases as men and women grow older. Most individuals who are diagnosed with the condition have reached their mid-60s.
- Gender – Men have a greater potential risk of developing multiple myeloma compared to women, although scientists and researchers have yet to determine why.
- Ethnicity – African-Americans (blacks) have twice the chance of developing multiple myeloma compared to Caucasians (whites) in the U.S.
- History of MGUS – Each year approximately one percent of all individuals who have monoclonal gammopathy of undetermined significance in America will develop multiple myeloma.
Multiple Myeloma Causes
Scientists have not yet found a clear cause of myeloma. However, doctors believe the condition starts with a single abnormal plasma cell deep in the marrow of the bone that can rapidly multiply. The abnormality in the defective blood cell can cause it not to mature and die off.
Instead, the cell continuously reproduces and accumulates an overwhelming amount of cancer cells that overtake the healthy cells in bone marrow. This leads to fatigue and the body's ability to fight off infection. Even though the myeloma cells continue to produce antibiotics, they are also defective and unusable by the body. Instead, the myeloma abnormal antibodies will build up in the body and lead to significant issues including damage one or both kidneys.
In addition, there also complications associated with multiple myeloma that include:
- Bone Issues – The disease can lead to bone problems including bone pain, broken bones, and thinning bones.
- Frequent Infections – The development of myeloma cells will inhibit the ability of the body to fight off infections.
- Taking contaminated pharmaceutical drugs - Popular prescribed drugs, including Zantac and Valsartan have been associated with multiple myeloma.
- Reduced Kidney Function – The condition is known to create kidney function problems including kidney failure. This is thought to be caused by elevated calcium levels in the bloodstream that erodes bones and interferes with the kidneys capacity to filter waste from the bloodstream.
- Anemia (low red blood cell count) – Anemia is often the result of myeloma cells crowding out normal healthy blood cells.
While the most common symptoms associated with multiple myeloma are easy to identify, they often mimic other diseases and conditions which might be difficult to diagnose until the disease has progressed to an advanced stage. Because of that, the doctor must determine if the persistent symptoms and signs the patient is experiencing are directly associated with the cancer. Common multiple myeloma symptoms include:
- Loss of appetite
- Bone pain, especially in the chest or spine
- Excessive thirst
- Weight loss
- Frequent infections
- Numbness or weakness in the legs
Multiple myeloma is rarely identified while it is in its initial stages unless the patient is undergoing routine blood tests that revealed an abnormally high level of protein in the bloodstream.
Diagnosing the Condition
Typically, the doctor will verify a diagnosis of multiple myeloma after performing a comprehensive physical examination, discussing the patient's symptoms and reviewing complicated test results. Some of these procedures and tests include:
- Plasma Cell Tumor Biopsy – The doctor is looking for elevated blood calcium levels, anemia (lower than usual red blood cell counts), or kidney function, abnormalities in bone and bone marrow as seen in an MRI scan and imaging studies that revealed holes and bones caused by tumor growth.
- Complete Blood Count – This test will measure the bloodstream levels of white blood cells, red blood cells, and blood platelets. The test might reveal a high number of myeloma cells in bone marrow or anemia, involving low red blood cell counts.
- Quantitative Immunoglobulin – This test can reveal the level of various antibodies in the bloodstream to determine if they are abnormally low or high.
- Electrophoresis – The doctor will perform an SPEP (serum protein electrophoresis) test to measure bloodstream immunoglobulins and identify monoclonal immunoglobulin, which is an abnormal protein that is often detected in the initial step necessary to accurately diagnose multiple myeloma.
- Blood Chemistry Tests – Certain tests can detect the levels of creatinine, blood urea nitrogen, calcium, albumin, and other electrolytes in the bloodstream.
- Immunohistochemistry Test – A pathologist will add certain man-made antibodies to the biopsy sample to better see its makeup and abnormalities under a microscope. This tells often identifies myeloma cells when other tests are inconclusive.
- Flow Cytometry – This test identifies certain substances on myeloma cells and other abnormal cells in the body's bone marrow that could be lymphoma cells, other forms of cancer or noncancerous conditions.
- Cytogenetics – Doctors uses this complex technique to evaluate long strands of DNA chromosomes in normal bone marrow to help identify myeloma cells. This is because myeloma cells often develop with abnormal chromosomes including too many or too few chromosomes.
- Fine Needle Aspiration Biopsy – This test requires the insertion of a very thin long needle attached to a syringe that withdrawals tiny amounts of lymph node or tumor tissue. While this procedure does not require surgery, it cannot remove sufficient quantities of tissue to verified diagnosis of multiple myeloma.
Treating Multiple Myeloma
Multiple myeloma treatments will usually help individuals who are suffering from a compromised kidney, high blood calcium levels, anemia, and/or lytic bone lesions. The most beneficial and effective treatment for multiple myeloma involves transplanting stem cells. This procedure requires a machine to remove some of the patient's stem cells which will be frozen and stored. In some cases, non-related donors provide stem cells.
As a part of the procedure, the patient undergoes high-dose chemotherapy that destroys nearly all the cells residing in the patient's bone marrow. This includes abnormal plasma cells that are causing the disease along with healthy cells. Once that procedure is over, the donor or patient's stored stem cells are injected into the veins which will travel to the body's bone marrow and eventually multiply creating healthy, new blood cells.
While this procedure does not cure the disease, it can increase the patient's lifespan. Typically, the patient undergoing this procedure will display numerous side effects from the medications taken concomitantly with chemotherapy. The doctor will often prescribe a corticosteroid like prednisone or dexamethasone to reduce common side effects or Interferon to keep the disease in remission after chemotherapy treatments have stopped.