Comprehensive notes Multiple Myeloma Awareness Month by providing resources to about the disease, ways to reduce risk, and treatment options.
Comprehensive Cancer Centers notes that the arrival of March brings Myeloma Awareness Month. The practice is grateful for organizations like the Leukemia & Lymphoma Society (LINK 3) at the forefront of the fight against myeloma. Collective efforts have seen significant progress over the past decade, with new therapies resulting in better overall survival. The vision of the month is to transform treatment and care for all those impacted by myeloma.
A great way to recognize the month is to learn more about the disease, ways to reduce risk, as well as treatment options. To begin, Multiple myeloma is a cancer that originates in plasma cells, a type of white blood cell responsible for producing antibodies that help the body fight infections. In multiple myeloma, these plasma cells become cancerous, multiply uncontrollably, and accumulate in the bone marrow, disrupting the production of healthy blood cells and causing various complications.
Plasma cells are a crucial component of the immune system. They reside in the bone marrow, the soft tissue inside bones where blood cells are produced. When the body encounters an infection, plasma cells produce antibodies that target and neutralize the pathogens. However, in multiple myeloma, cancerous plasma cells proliferate rapidly, crowding out normal blood-forming cells in the bone marrow. This leads to a deficiency in healthy blood cells, resulting in anemia (low red blood cell count), thrombocytopenia (low platelet count), and leukopenia (low white blood cell count).
Furthermore, instead of producing infection-fighting antibodies, the malignant plasma cells secrete abnormal proteins called monoclonal proteins (M proteins) or paraproteins. These M proteins serve no useful purpose and can cause damage to various organs, particularly the kidneys. In some cases, these abnormal proteins may also be found in the urine, where they are known as Bence Jones proteins.
Risk Factors for Multiple Myeloma
The exact cause of multiple myeloma remains unknown, but several risk factors have been identified that may increase the likelihood of developing the disease:
- Age: The risk of multiple myeloma increases with age, with most diagnoses occurring in people in their late 60s.
- Sex: Men are more likely to develop multiple myeloma than women.
- Race: African Americans have a higher incidence of multiple myeloma compared to other racial groups.
- Family history: Having a first-degree relative (parent, sibling, or child) with multiple myeloma increases the risk of developing the disease.
- Monoclonal gammopathy of undetermined significance (MGUS): MGUS is a condition characterized by the presence of M proteins in the blood but at lower levels than in multiple myeloma.
It’s important to note that having one or more risk factors does not guarantee that a person will develop multiple myeloma. Many people with risk factors never develop the disease, while others with no apparent risk factors may be diagnosed with it.
Symptoms of Multiple Myeloma
Multiple myeloma often presents with no symptoms in its early stages, making it challenging to diagnose. However, as the disease progresses, various symptoms may manifest, including:
- Bone pain: This is a common symptom, often felt in the back, ribs, or hips. The pain can range from mild to severe and may worsen with activity.
- Fractures: Multiple myeloma weakens the bones, making them more susceptible to fractures, even with minor injuries.
- Fatigue: Anemia, caused by the reduced production of red blood cells, can lead to persistent fatigue and weakness.
- Frequent infections: The decreased production of healthy white blood cells impairs the immune system, increasing the risk of infections.
- Weight loss: Unexplained weight loss can occur due to various factors, including decreased appetite and the effects of the disease on metabolism.
- Nausea and vomiting: These symptoms may arise from hypercalcemia (high calcium levels in the blood), a complication of bone destruction in multiple myeloma.
- Constipation: Hypercalcemia can also contribute to constipation.
- Confusion or mental fog: In some cases, multiple myeloma can affect cognitive function, leading to confusion or difficulty concentrating.
- Kidney problems: The M proteins produced by myeloma cells can damage the kidneys, leading to impaired kidney function or even kidney failure.
Diagnosis of Multiple Myeloma
Diagnosing multiple myeloma typically involves a combination of tests and procedures, including:
- Blood tests: These tests can detect the presence of M proteins, calcium, and other substances that may indicate multiple myeloma.
- Urine tests: Urine analysis can reveal the presence of Bence Jones proteins.
- Bone marrow biopsy: A sample of bone marrow is extracted and examined under a microscope to identify myeloma cells and assess their proportion.
- Imaging tests: X-rays, CT scans, or MRI scans may be used to visualize bone damage and identify any tumors or lesions.
Treatment Options for Multiple Myeloma
While there is currently no cure for multiple myeloma, various treatment options are available to manage the disease, alleviate symptoms, and improve the quality of life for patients. The choice of treatment depends on several factors, including the stage of the disease, the patient’s overall health, and individual preferences.
- Induction therapy: the initial treatment given to newly diagnosed patients with multiple myeloma. It aims to reduce the number of myeloma cells and control the disease before further treatment is administered. Induction therapy commonly involves a combination of medications, such as:
- Proteasome inhibitors: These drugs target proteasomes, which are cellular structures involved in protein breakdown. By inhibiting proteasomes, these drugs disrupt the growth and survival of myeloma cells. Examples include bortezomib, carfilzomib, and ixazomib.
- Immunomodulatory drugs (IMiDs): These drugs modulate the immune system and have anti-tumor effects. Examples include thalidomide, lenalidomide, and pomalidomide.
- Chemotherapy: Chemotherapy drugs kill rapidly dividing cells, including myeloma cells. Examples include melphalan and cyclophosphamide.
- Corticosteroids: These drugs, such as dexamethasone and prednisone, have anti-inflammatory and anti-tumor properties.
Stem Cell Transplantation
Stem cell transplantation (SCT) is a procedure in which healthy stem cells are used to replace damaged or destroyed bone marrow. It is a common treatment option for eligible patients with multiple myeloma, particularly younger and otherwise healthy individuals. There are two main types of SCT:
- Autologous SCT: This involves collecting the patient’s own stem cells before high-dose chemotherapy is administered. The collected stem cells are then reinfused after chemotherapy to help the bone marrow recover.
- Allogeneic SCT: This involves using stem cells from a donor, typically a close relative, who is a match for the patient. Allogeneic SCT carries a higher risk of complications but may offer a better chance of long-term remission in some cases.
Consolidation Therapy
Consolidation therapy is given after induction therapy and/or SCT to further reduce the number of myeloma cells and prolong remission. It may involve additional cycles of chemotherapy, IMiDs, proteasome inhibitors, or targeted therapies.
Maintenance Therapy
Maintenance therapy is administered after consolidation therapy to help prevent the recurrence of multiple myeloma. It typically involves low-dose IMiDs or proteasome inhibitors and may continue for an extended period.
Targeted Therapy
Targeted therapies are drugs that specifically target certain characteristics of cancer cells, such as their growth or survival pathways. Several targeted therapies have been approved for use in multiple myeloma, including:
- Daratumumab: This monoclonal antibody targets the CD38 protein found on myeloma cells, leading to their destruction.
- Elotuzumab: This monoclonal antibody targets the CS1 protein on myeloma cells, enhancing the activity of natural killer cells to kill myeloma cells.
- Selinexor: This drug inhibits the exportin 1 (XPO1) protein, which is involved in transporting proteins out of the cell nucleus. By inhibiting XPO1, selinexor disrupts the growth and survival of myeloma cells.
Radiation Therapy
Radiation therapy uses high-energy beams to kill cancer cells. It may be used to treat localized areas of myeloma, such as plasmacytomas (solitary tumors), or to relieve pain from bone lesions.
Supportive Care
Supportive care is an essential aspect of multiple myeloma management. It focuses on addressing complications of the disease and side effects of treatment, such as:
- Pain management: Pain relievers, including opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), may be used to manage bone pain.
- Infection prevention and treatment: Patients may receive antibiotics or antiviral medications to prevent or treat infections.
- Anemia management: Erythropoiesis-stimulating agents (ESAs) may be used to increase red blood cell production and alleviate anemia.
- Kidney protection: Measures to protect kidney function, such as hydration and medications, may be necessary.
- Bone health: Bisphosphonates or denosumab may be used to strengthen bones and prevent fractures.
Living with Multiple Myeloma
Living with multiple myeloma can be challenging, both physically and emotionally. However, with advances in treatment and supportive care, many patients can achieve long periods of remission and maintain a good quality of life. It’s crucial for patients to work closely with their healthcare team to develop a personalized treatment plan and manage any side effects or complications.
In addition to medical treatment, lifestyle modifications can also play a role in managing multiple myeloma and improving overall well-being. These may include:
- Maintaining a healthy diet: A balanced diet rich in fruits, vegetables, and whole grains can help support the immune system and overall health.
- Regular exercise: Moderate exercise can help improve bone strength, reduce fatigue, and enhance mood.
- Stress management: Techniques such as meditation, yoga, or deep breathing exercises can help manage stress and anxiety.
Comprehensive Cancer Centers Can Help
Physicians at Comprehensive Cancer Centers provide a variety of treatment options for multiple myeloma. To schedule an appointment with the team at Comprehensive, please call 702-952-3350.
The content in this post is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
