All about Multiple Myeloma

There seems to be increasing news about multiple myeloma which is both a good thing and a bad thing. Good because the news is about results from new research and advances in treatments; bad because so many new cases are being diagnosed every year. At the moment there are nearly 4,000 new cases of multiple myeloma being identified in the UK each year; around 80% of patients are over the age of 65.

Myeloma, as it is also called, is a type of cancer arising from plasma cells which are normally found in the bone marrow. Plasma cells form part of our immune system.

Normal plasma cells produce antibodies (also called immunoglobulins) to help fight infection. In myeloma, the DNA of a plasma cell is damaged causing it to become malignant or cancerous. These abnormal plasma cells are known as myeloma cells. Unlike many cancers, myeloma does not exist as a lump or tumour. Instead, the myeloma cells normally divide and expand within the bone marrow.

Myeloma affects multiple (hence multiple myeloma) places in the body where bone marrow is normally active in an adult, i.e. within the bones of the spine, skull, pelvis, the rib cage, and the areas around the shoulders and hips. The areas usually not affected are the extremities: that is the hands, feet, and lower arm / leg regions. This is very important since the function of these critical areas is usually fully retained.

Common initial problems from myeloma are:

• bone pain; the middle or lower back, the rib cage and the hips are the most frequently affected placed. The pain is often persistent and described as dull and aching.
• bone fractures; the bones that most commonly fracture due to myeloma are the spine and the ribs.
• fatigue; an overwhelming tiredness is often present. This can be due to anaemia.
• anaemia; a reduction in the number of red blood cells can cause fatigue, weakness and breathlessness.
• infection; this is more common in myeloma patients because the disease interferes with the immune system
• hypercalcaemia; this is a condition where the level of calcium in the blood is too high and can result in symptoms such as thirst, nausea, vomiting and constipation.
• kidney damage; this can occur for various reasons, including the abnormal protein produced by myeloma cells damaging the kidneys.
  

Diagnosis of multiple myeloma involves several tests and investigations ; myeloma is a very individual disease and results from tests can vary considerable from patient to patient. While obtaining the diagnosis is of course crucial, it is also important to obtain an accurate picture of the disease in the patient so that the best programme of treatment can be prepared.

One key test done in cases of myeloma is on the levels of paraprotein. Changes here are usually a good indicator of changes in the activity of the myeloma. No paraprotein detectable after treatment means you are usually thought to be in complete remission. This is unusual except after high-dose therapy and stem cell transplantation. If the paraprotein levels have fallen and are remaining at the same level, although still detectable, then this is considered to be partial remission and is called a plateau phase.

Other tests include x-rays to check bone damage; a bone marrow biopsy; full blood counts to check white cell counts, haemoglobin levels and platelets; kidney function, calcium measurement, albumin measure and a check on Beta 2 microglobulin.

Treatments

Because myeloma is such an individual disease, the management of the problem can vary considerably according to the individual patient. In the past, the most common treatments were chemotherapy, steroids, high-dose therapy and stem cell transplantation in suitable cases.

However, considerable research is being undertaken on this disease and recently two new treatments have been introduced into the range of drugs available, thalidomide and bortezomib , which research has shown to have good results. There are also a number of supportive treatments to help reduce the symptoms and complications that can arise from myeloma. These include a group of drugs called cisphosphonates which are used to treat bone disease and bone pain, and erythropoietin for anaemia.

Treatments for myeloma can be very effective at halting its progress, controlling the symptoms, and improving quality of life, but they are not able to cure it. Even after successful treatment, regular monitoring is needed in case the myeloma comes back.

A good area for support is Myeloma UK, a charity organisation dealing exclusively with myeloma and its related disorders. They have a dedicated myeloma information line on 0800 980 3332 and an excellent website on www.myeloma.org.uk

The MMRF, the Multiple Myeloma Research Foundation, also has a lot of useful information. Visit them at www.multiplemyeloma.org

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