Cancer of the plasma cells

Multiple myeloma or plasma cell myeloma is the official name of cancer of the plasma cells. The white blood cells usually produce a normal number of antibodies. There are no symptoms of this condition, but if it reaches an advanced stage it leads to pain in the bones, bleeding, anemia, infections, and amyloidosis. Those suffering from this disease usually face a relapse of multiple myeloma after complete remission.

Causes for multiple myeloma are also unknown but many factors contribute to it. These factors include family history, obesity, drinking, exposure to radiation, and chemicals. The main reason being abnormal plasma cells producing an irregular and uncharacteristic numbers of antibodies, causing thickness in the blood and kidney problems. This can form mass/masses in the bone marrow [the soft tissue]. The presence of more than one mass is called multiple myeloma.

Multiple myeloma can be diagnosed through blood and urine tests that look for abnormal numbers of antibodies, conducting bone marrow biopsy, medical imaging to look for bone lesions, and high levels of blood calcium.

Multiple myeloma can be treated but is not entirely curable and has the chance of being relapsed. Remission is possible only with steroids, thalidomide, chemotherapy, stem cell transplantation, lenalidomide, etc. The current treatment has increased life of suffering patients by around five years. But in USA, over 11,000 people die every year due to multiple myeloma and/or a relapsed condition of it.

Relapse of multiple myeloma happens to those who were initially treated and malignancy reoccurred or there has been progression in the disease when not being treated. These patients of relapsed multiple myeloma have failed to respond to therapy.

Myeloma affects many organs but the symptoms vary. Common symptoms include renal failure, anemia, bone lesions, weight loss, and infections like pneumonia.

• Bone pain is common and affects 70% of patient. It affects the spine and ribs, it worsens with activity. The constant local pain indicates a bone fracture.
• Anemia happens when the bone marrow is replaced by the invading tumor cells and it inhibits the production of normal red blood cells.
• Proteins secreted by the malignant cells or myeloma cells also called antibodies, leading to abnormal levels of proteins in the blood. These proteins get excreted through the kidneys damaging them.
• The most common infection is pneumonia. The greatest risk here is of infection in the initial month before chemotherapy due to immune deficiency. Although, immunoglobulin level is high but these antibodies are ineffective. Symptoms include fatigue, confusion, headache, visual changes, loss of bladder control, peripheral neuropathy, carpal tunnel syndrome, retinopathy, neurological problems, hyperviscosity of the blood, in later stages it may lead to numbness in hands and feet, paraplegia.

There are many factors that lead to the risk of developing multiple myeloma. Monoclonal gammopathy, smoldering multiple myeloma, obesity which increases the body mass, family’s disposition, hyperphosphorylation of proteins which is inherited in the family which is common in African Americans.

Relapse in multiple myeloma is credited to tumor heterogeneity, all this depends on the patient and his condition, the prior treatments he/she has undergone. Options in treatment will include taking the same treatment/agent or other agents with stem cell transplant. Later on, the patient shows resistance to treatment when some new type of modalities may be added to the standard treatment.

There have been many new additions of therapy including bortezomib, less toxic thalidomide and pomalidomide. Now patient’s survival chances are more with stem cell transplants with combination of drugs. Other new treatments are being discovered.

Kidney failure is a part of multiple myeloma, which can be either acute or chronic. The acute failure gets resolved with the calcium and protein levels coming under control. The chronic failure may be on the type of kidney failure and may need dialysis.

There are many options that available to manage the disease with oral medicines like ixazomib, panobinostat, carfilzomib, elotuzumab, dexamethasone, and daratumumab.

Myeloma palliative care requires proper guidelines for the person who has it. The palliative along with curative treatment helps to deal with the side effects of the disease like nausea and pain.

Survival of the patients is around 35% with five year increase in the survival rate. However, the prediction is not the same for every person suffering from multiple myeloma. The onset age is 70 years and many older patients are suffering from serious diseases while younger patients survive longer. Prognosis is calculated on how fast the tumor is growing and how fast the disease is spreading. Many types of tests can be performed to calculate the spread of myeloma.

There are myeloma centers across USA and they also do genetic testing to determine if that particular gene is present in a person and will cause multiple myeloma or its relapse. The oncologists can determine in advance if a person is a high or low risk individual for myeloma cancer.

Complications in multiple myeloma and its relapse also vary according to the individual and the spread of the disease. Studies have indicated that the difference in the DNA creates various different abnormalities and the treatment should vary according to the DNA variation. The research is on for better medicines depending on the DNA variations so better results can be achieved.