Multiple myeloma (MM) is a form of cancer that affects the plasma cells (a type of white blood cell that is most commonly located in the bone marrow).
Under normal conditions the plasma cells produce proteins called immunoglobulin (or antibodies) that circulate the blood tasked with the role of defence. They find and attack all strange material in the organism.
MM causes the excessive production of these cells, displacing the normal bone marrow cells (making the normal production of the red blood cells, white blood cells and platelets difficult) and injuring the bones that contain the bone marrow (bringing pain and potential bone fractures). In addition, these plasma cells produce abnormal immunoglobulin in excessive quantities that can be detected in the blood and/or the urine. These immunoglobulin interfere excessively in the diverse roles of the blood, in normal functioning of the kidneys and causing the development of infections.
The average age of MM patients is 65 years old, and it is very uncommon to suffer the disease before 50. The number of people contracting the disease is high, with 30-50 in a million new cases each year, accounting for 1% of all cancers and 10% of blood cancers.
Joan, ex-multiple myeloma patient
The main symptom is pain in the bones. It can be localized on any part of the body but the most frequent places are in the spine and the ribs. Other possible manifestations of MM are due to the lack of red blood cells (tiredness, weakness, palpitations, and dizziness) or the alteration of the normal pattern of the platelets (easy bruising, bleeding nose and gums). In addition, weight loss, frequent infections, bone fractures without cause and on occasions the evolution of tumors in the plasma cells (plasmacytomas) can all be experienced by the patient.
The diagnosis of MM is based on the presence of an abnormally high number of a specific immunoglobulin in the blood or in the urine and an excess of plasma cells in the bone marrow. To establish a diagnosis it is necessary to carry out several blood tests and bone marrow examinations (taken by a needle puncture from the sternum or the hip bone). Similarly it is necessary to take a urine sample over 24 hours in order to establish if an abnormal immunoglobulin is present and if so, what quantity. Finally, radiographs of the entire skeleton should be carried out in order to determine if the disease has caused any damage.
Milder and emerging forms may not require treatment, with periodic checks sufficient to determine the evolution of the MM and to maintain a stable progress. In cases that require treatment, intravenous chemotherapy will be the common method applied to patients younger than 70 years old, and orally to elder patients. The aim of the treatment is always to halt the evolution of the disease and improve the symptoms felt by the patient, as a complete cure is sadly not achievable. Despite this fact, many patients successfully battle to the point where they do not suffer from any symptoms (complete remission) or merely a few symptoms (partial remission) and produce an analytical anomaly that can be maintained over a period of months or even years. To obtain these results patients receive diverse combinations and dosages of chemotherapy.
Teresa's story, ex-multiple myeloma patient
The only treatment for MM which holds the possibility for a cure is a bone marrow transplant from a compatible donor. Unfortunately, the fact that the majority of patients are elderly and the procedure contains high levels of toxicity means that this treatment is rarely an option. It is currently under investigation as to whether a new method of transplant with lower toxic levels (transplants of reduced intensity) could be used to treat these patients. For patients that are not considered as candidates for this type of transplant, an autologous bone marrow transplant could be carried out in order to improve and prolong the response achieved with chemotherapy.
Radiotherapy is very effective at combating bone pains and localized forms of the disease.
The bisphosphonates (etidronate, pamidronate, clodronate, zoledronate) are agents that inhibit the activity of the osteoblasts (cells responsible for the destruction of the bone) and promote the recalcification of the bone. Therefore it is normally administered once a month over an extended period of time for all myeloma patients.
If you would like more information please consult the following web pages:
- Multiple myeloma and other neoplasias, National Cancer Institute
- Multiple myeloma, Medline Plus
- Multiple myeloma and other neoplasias, University of Bonn
- ME - Myeloma Euronet
- Interactive presentation from the medical encyclopedia Medline
- Myeloma, The Leukaemia & Lymphoma Society