What is Myeloma?
What is Multiple Myeloma?
Multiple myeloma is a cancer of plasma cells, a type of white blood cell, that attacks and destroys bone. The disease can be difficult to diagnose and often results in different treatment recommendations from doctors. The term “multiple myeloma” is derived from the multiple areas of bone marrow that are affected by the disease. Since plasma cells are antibody-producing cells, patients have high amounts of a single type of antibody called an M-protein in their blood and/or urine and these levels are used to track the disease. These patients often have reduced blood cell counts leading to anemia and decreased amounts of normal antibodies which frequently compromise the body’s immune system rendering them more susceptible to infections. Collections of these plasma cells in the bone can cause tumors leading to a reduction in bone strength. This often leads to fractures as well as bone pain.
How is Multiple Myeloma Treated?
The disease progresses at different rates depending on the patient and at this time there is no known cure. Despite this, multiple myeloma is very treatable, and outcomes are continuing to improve. Current treatments aim to control the disease and its symptoms helping to allow the patient to live an excellent quality of life in most cases. Treatment is intended to relieve discomfort and increase functionality through reversal of any kidney damage, improvement in blood counts and control of bone damage. This is accomplished using different combinations of drugs and less commonly radiation and/or surgery to relieve discomfort and increase functionality. Today, drug combination treatments often arrest the course of the disease and achieve remissions that last for years in many cases. Multiple myeloma patients eventually develop resistance to their current treatment; and, as a result, will require a change in their drugs. Today, the number of available treatments is growing rapidly. As a result, patients receive many different therapies during their disease course.
Who is at Risk?
Approximately 1,000 people worldwide are diagnosed with multiple myeloma every day. The disease is found more commonly in middle-aged or elderly persons. It is also more prevalent in men than women African Americans are at higher risk to develop myeloma than Caucasians. The average survival rate is approximately 5-6 years, depending on the level of the disease state.
What are the Disease States?
There are 4 different types of myeloma-like states starting with the lowest risk: Monoclonal gammopathy of undetermined significance (MGUS) Diagnosed when the M-protein is found in the body but there are not enough plasma cells to call it myeloma. No treatment is required or recommended for these patients unless they have significant bone loss requiring bone strengthening agents. There is a 1% chance per year that this condition will progress to a myeloma or a related disease requiring treatment. An analogy would be how HIV infection may transform to AIDS. You can have the HIV virus, but not develop AIDS. Smoldering myeloma This is characterized by enough plasma cells in the bone marrow (> 10%) to call it myeloma but there are no disease related symptoms. Patients require close monitoring and no treatment except perhaps with bone strengthening drugs. Plasmacytoma This is usually diagnosed when a single group of abnormal plasma cells grows in a local area of bone or soft tissue. This can lead to the development of multiple growths or tumors (i.e., multiple myeloma). Radiation treatment is a common therapy. Rarely is tumor removal by surgery possible. Symptomatic or active myeloma Some of the typical symptoms of myeloma are present. These include:
- Bone damage—Patient experiences bone pain, fractures or collapse of bones in the spine
- High calcium levels are in the blood from bone loss–Patient feels tired, weak and may develop kidney failure
- Anemia (a decrease in the production of red blood cells)- Patient feels fatigue, weakness and short of breath
- Kidney damage is most commonly from the myeloma protein or high calcium levels—Patient feels mental confusion, dehydration, constipation, fatigue, and weakness
- Compromised immune system—Patient is more susceptible to infection
How Does Myeloma Affect the Bones?
Myeloma most commonly affects the spine, ribs, pelvis, and long bones of the arms and legs with the main symptoms being pain and fractures. The debilitating effects of the bone weakness can occur from the inner bone marrow to the outer bone surface. Soft spots, or osteolytic lesions, are like “holes” in the bone, and appear as such when x-rayed. These lesions cause pain and can often lead to fractures and the collapse of bones especially in the spine. Bone destruction in myeloma is caused by myeloma cells activating bone-resorbing, or bone-eating cells called osteoclasts.
What connection do breast, prostate and lung cancer have with bone cancer?
It is common for breast, prostate and lung cancers to spread to the bone. Bone marrow provides an effective “soil” for the “seed” of the cancer to spread and grow. There appears to be a symbiotic relationship between the cancer and the bone marrow “soil” much like plants taking nourishment from the soil and giving back nutrients to the soil through decomposition. Most previous research for metastatic bone disease has ignored this potentially important link in targeting both the “soil” as well as the “seed” for patients with this form of cancer in the bone.
