The month of March is Myeloma Awareness Month.
What is Myeloma?
Myeloma is a cancer of the bone marrow plasma cells (a type of white blood cell). It is part of a spectrum of disorders known as “plasma cell dyscrasias” or “plasma cell neoplasms,” that include Monoclonal gammopathy of undetermined significance (MGUS), Smoldering myeloma (SM), Multiple myeloma (MM), light-chain amyloidosis, Waldenstrom macroglobulinemia (WM), and Plasma cell leukemia.
Healthy plasma cells are part of the immune system and make a type of protein, called antibodies (also called immunoglobulins), which help fight infection. In myeloma, a plasma cell undergoes a cancerous change caused by one or more acquired genetic mutations.
The term “multiple myeloma” was coined in 1873, by a Russian doctor J. Von Rusitzky after finding eight different types of bone marrow tumors in a single patient.
Disease occurs in adults older than 50 years
Multiple myeloma accounts for 10 to 15 percent of blood cancers, with an incidence of 1.0 per 100,000. However, there is evidence that the incidence of myeloma is gradually increasing especially in urban India. The disease generally occurs in adults older than 50 years, and affects slightly more men than women.
Myeloma cells (malignant plasma cells) release chemicals that cause an imbalance, with greater bone destruction and less new bone formation. This may result in bone thinning or holes in the bones termed osteolytic lesions. Bones become soft, fragile, and easily breakable. Patients often present with bone pain, very often in their back and fractures from even simple activities.
When more bone destruction than bone formation occurs, calcium may be released into the blood, which can cause increased thirst and urination, constipation and, in extreme cases decreased alertness and kidney failure.
When myeloma cells crowd out the normal bone marrow cells, the decrease in the number of red blood cells or hemoglobin concentration causes anemia.
Symptoms of myeloma
Patients can start feeling tired, dizzy, pale and short of breath. High levels of antibodies may be harmful to the kidneys. While the myeloma cells are most commonly found in the bone marrow, they may accumulate in the bones, skin, muscle or lungs known as “plasmacytomas.”
The diagnosis of myeloma is based on confirmation of the presence of plasma cells of more than 10 percent in the bone marrow aspiration sample, unusual amounts of monoclonal protein, referred to as “M spike,” and evidence of end-organ damage that can be attributed to the disease (CRAB features) – elevated calcium, renal insufficiency (raised serum creatinine), anemia (low hemoglobin concentration), bone lytic lesions (on x-rays, MRI or PET-CT scans). Additional molecular tests are done to classify myeloma as “high risk” or “standard risk.”
New treatments available for treatment
We have come a long way since treating patients with rhubarb, quinine, and leeches when the disease was first discovered. The arsenal against myeloma is expanding, and the pronounced depth of response possible with new treatments (Carfilzomib, Daratumumab, CAR-T cells, etc) has resulted in doubling of overall survival. Treatment usually includes a combination of targeted agents and/or standard chemotherapy.
Initial therapy is often followed by Autologous stem cell transplant in eligible patients to consolidate the response achieved and extend survival. Decisions regarding clinical use of newer treatments are made on the basis of the magnitude of the observed differences in efficacy, characteristics of the patients, relative safety, ease of use, and cost.
(Dr. Madhav Danthala is Consultant Hemato-Oncologist, and Bone Marrow Transplant physician- Yashoda Hospitals, Hyderabad)
