Multiple myeloma, also known as Kahler’s disease, is a rare type of blood cancer characterized by excessive production (proliferation) and improper function of certain cells (plasma cells) found in the bone marrow.
Plasma cells, which are a type of white blood cell, are produced in the bone marrow and normally reside there. Excessive plasma cells may eventually mass together to form a tumor or tumors in various sites of the body, especially the bone marrow. If only a single tumor is present, the term solitary plasmacytoma is used. When multiple tumors are present or the bone marrow has greater than 10% plasma cells, the term multiple myeloma is used.
Plasma cells are a key component of the immune system and secrete a substance known as immunoglobulin proteins (M-proteins), a type of antibody. Antibodies are special proteins that the body produces to combat invading microorganisms, toxins, or other foreign substances. Overproduction of plasma cells in affected individuals results in abnormally high levels of these proteins within the body, referred to as M proteins.
There are two main types of multiple myeloma:
• Indolent myeloma.
This type usually develops slowly without noticeable symptoms. It doesn’t cause bone tumors, only small increases in M protein and M plasma cells.
• Solitary plasmacytoma.
This type causes a tumor to form, typically in the bone. It usually responds well to treatment, but it needs close monitoring.
Sign & Symptoms –
Early signs and symptoms can vary and may not appear at all. But if they do occur, they typically include:
• bone pain (particularly in your back or chest)
Initially, symptoms may not be noticeable. However, as the disease progresses, most people will experience at least one of four major types of symptoms.
These symptoms are generally referred to by the acronym CRAB, which stands for:
• C = calcium (elevated levels)
• R = renal failure
• A = anemia
• B = bone damage
▪︎ High levels of calcium symptoms
High levels of calcium in your blood come from affected bones leaking calcium. Too much calcium can cause:
• extreme thirst
• upset stomach
• loss of appetite
Confusion and constipation are also common symptoms of increased calcium levels.
▪︎ Kidney failure symptoms
High levels of M protein in your body can cause kidney damage or failure. Potential symptoms of kidney damage or failure include:
• a reduced amount of urine
• swelling of your legs, ankles, and feet
• unexplained shortness of breath
• excessive drowsiness or fatigue
• persistent nausea
• pain or pressure in your chest
▪︎ Anemia symptoms
Anemia can occur when cancerous cells outnumber red blood cells in your bone marrow. Symptoms of anemia include:
▪︎ Bone damage symptoms
Bone injuries and fractures occur when cancerous cells invade your bone and bone marrow. The lesions caused by the cancer cells can cause bone pain, especially in the:
▪︎ Additional symptoms
Additional symptoms of multiple myeloma may include:
• weakness or numbness, especially in your legs
• unintentional weight loss
• problems with urination
• repeated infections
• vision loss or vision problems
Causes & Risk Factors –
Experts aren’t sure what causes multiple myeloma. Symptoms occur as a result of a process that is initiated by the abnormal multiplication of plasma cells in bone marrow.
Scientists suspect there may be a variety of causes that may include environmental factors (e.g., the effects of exposure to radiation), genetic abnormalities, and/or additional factors that may play varying contributing roles.
One factor of interest to researchers is that many myeloma cells have been found to be missing all or part of chromosome 13. Also, the development of multiple myeloma is preceded in virtually all cases by a condition called monoclonal gammopathy.
The specific symptoms of multiple myeloma result from excessive and unnecessary growth (neoplastic proliferation) of plasma cells.
But you’re more likely to get it if:
• You’re older than 65
• You’re male
• You’re African American
• You have a family member with it
• You’re overweight or obese
• You’ve been exposed to radiation
• You’ve had contact with chemicals used in rubber manufacturing, woodworking, or firefighting; or in herbicides
Complications of multiple myeloma include:
• Frequent infections.Myeloma cells inhibit your body’s ability to fight infections.
• Bone problems.Multiple myeloma can also affect your bones, leading to bone pain, thinning bones and broken bones.
• Reduced kidney function.Multiple myeloma may cause problems with kidney function, including kidney failure.
• Low red blood cell count (anemia).As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems
Your doctor may suspect multiple myeloma if you have a blood test for something else and it shows:
• Too much calcium in your blood (hypercalcemia)
• Too few red blood cells (anemia)
• Kidney problems
• High total protein levels in your blood, but low levels of one called albumin (your doctor may say you have a “globulin gap”)
To confirm a diagnosis, you might have blood tests including:
• A complete blood count (CBC). It measures the different kinds of cells in your blood.
• Blood urea nitrogen (BUN) and creatinine. These check how well your kidneys are working.
After your test results come in, your doctor may want to do a bone marrow biopsy. They’ll put a needle into a bone, usually in your hip, and take a sample of marrow to check the number of plasma cells in it.
You might get imaging tests. X-rays can show spots of bone damaged by multiple myeloma. You may also need a CT scan, MRI, or PET scan.
If you’re experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of multiple myeloma.
▪︎ Immediate treatment may not be necessary
If you have multiple myeloma but aren’t experiencing any symptoms (also known as smoldering multiple myeloma), you might not need treatment right away. Immediate treatment may not be necessary for multiple myeloma that is slow growing and at an early stage. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may involve periodic blood and urine tests.
If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.
▪︎ Treatments for myeloma
Standard treatment options include:
• Targeted therapy.
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Chemotherapy uses drugs to kill cancer cells. The drugs kill fast-growing cells, including myeloma cells. High doses of chemotherapy drugs are used before a bone marrow transplant.
Corticosteroid medications regulate the immune system to control inflammation in the body. They are also active against myeloma cells.
• Bone marrow transplant.
A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.
Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.
• Radiation therapy.
Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. It may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that’s causing pain or destroying a bone.
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