Explained: What Is Multiple Myeloma And How Can It Be Diagnosed?

Multiple myeloma, also known as myeloma or plasma cell myeloma, is a type of cancer that affects the plasma cells in the bone marrow. Plasma cells are white blood cells that produce antibodies to help fight off infections. In multiple myeloma, the abnormal plasma cells produce an excess of a specific type of antibody, known as monoclonal protein or M protein, which can damage the bones, kidneys, and other organs.

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Multiple myeloma accounts for approximately 10-15% of blood cancers. In fact, it is one of the most common blood cancer. It usually occurs in people over the age of 60, although it can also affect younger adults.

Timely diagnosis and treatment is key

The symptoms of multiple myeloma often include bone pain, fatigue, weakness, frequent infections, and anemia. Bone lesions consisting of minor fractures are seen in up to 70% of patients. Back pain due to fractures of the spine is one of the common initial manifestations and is the common reason for people to report to a doctor. Some people (up to 30%) may also experience kidney problems with abnormal kidney function tests.

Multiple myeloma diagnosis

- The first step is usually a complete blood count (CBC), which measures the number of red and white blood cells and platelets in the blood. In multiple myeloma, the CBC may show a low red blood cell count (anemia) and sometimes low white cells and platelet as well. Kidney functions may also detect abnormalities in the kidney.

- Other blood tests- These tests can detect abnormal levels of certain proteins in the blood that are produced by myeloma cells. For example, a test called serum protein electrophoresis (SPEP) can measure the amount of a protein called M-protein, which is produced by myeloma cells. This test can help determine how much abnormal protein is being produced by the abnormal plasma cells. Another test called serum-free light chain assay (FLC) can measure the levels of abnormal light chains, which are also produced by myeloma cells.

- Urine tests: These tests can detect the presence of abnormal proteins in urine that are produced by myeloma cells. For example, a test called urine protein electrophoresis (UPEP) can measure the amount of M-protein and other abnormal proteins in urine.

- Bone marrow biopsy: If the CBC, SPEP, and urine tests suggest the presence of multiple myeloma, then a bone marrow test will be required to confirm the diagnosis. This test involves taking a small sample of bone marrow from a hip bone or another bone and examining it under a microscope for the presence of myeloma cells.

- Imaging tests: These tests can help the doctor see any tumors or bone damage caused by myeloma. Common imaging tests include X-rays and CT scans. Advancements in imaging technology, such as PET-CT and MRI scans, have allowed for more precise assessment and can detect myeloma lesions earlier than traditional X-rays, which can be critical for early diagnosis and effective treatment. These tests can also help determine the stage of the disease and guide treatment decisions.

- Once a diagnosis of multiple myeloma has been confirmed, the treatment plan is tailored to individual needs based on age and fitness.

Treatment of Multiple Myeloma

Advance in the treatment of multiple myeloma is the use of precision medicine. Precision medicine involves using genetic testing to identify the specific genetic mutations that are driving the growth of myeloma cells. Once these mutations are identified, targeted therapies can be used to block their effects and stop the cancer from growing. This approach can lead to more personalized and effective treatment for each individual patient.

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Myeloma therapy doesn¡¯t usually need typical chemotherapy. Rather drugs for the therapy of multiple myeloma are designed to target specific proteins or pathways essential for the growth and survival of myeloma cells. Proteasome inhibitors, such as bortezomib, are one example of a targeted therapy used in multiple myeloma. These drugs block the breakdown of proteins in myeloma cells, leading to their death.

Another newer treatment option for multiple myeloma is monoclonal antibodies, which are designed to target specific proteins on the surface of myeloma cells. Daratumumab is an example of a monoclonal antibody used in multiple myeloma treatments. This drug helps the immune system recognize and attack myeloma cells more effectively.

Stem cell transplantation is one of the standard treatments for multiple myeloma. Stem cell transplantation involves collecting healthy stem cells from the patient or a donor and administering high doses of chemotherapy to kill cancer cells. The healthy stem cells are then infused back into the patient's body, helping to restore the immune system and blood cell production.

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Targeted Immunotherapy is a new treatment option that uses the body's immune system to fight cancer cells. One type of immunotherapy used in multiple myeloma is called CAR T-cell therapy. This treatment involves modifying the patient's own T-cells in a laboratory so that they can recognize and destroy myeloma cells more effectively.

Overall, the newer advances in the diagnosis and treatment of multiple myeloma offer hope for patients with this disease. With continued research and development, we may see even more effective treatments in the future. It is important for patients with multiple myeloma to work closely with their healthcare providers to determine the best course of treatment for their individual needs.

About the author: Dr. Ashish Dixit is a Consultant in Haematology Haemato Oncology and Bone Marrow Transplantation, Manipal Hospital Old Airport Road. All views/opinions expressed in the article are of the author.