Multiple myeloma, sometimes referred to as Kahler's disease, is a relatively rare type of blood cancer. It primarily originates in the bone marrow, the spongy tissue inside your bones where blood cells are produced, and can potentially impact the kidney's function.
The condition is a cancer of the plasma cells. Normally, plasma cells are a vital part of your immune system, a type of white blood cell situated in the bone marrow. Their role is to produce antibodies (proteins) that help the body fight off infections from viruses and bacteria.
In multiple myeloma, a plasma cell becomes cancerous and begins to multiply uncontrollably. These malignant cells can take up space in the bone marrow, thereby hindering the production of healthy blood cells. Furthermore, instead of creating beneficial, infection-fighting antibodies, the cancerous cells produce an abnormal, non-functional protein known as a monoclonal protein (M protein) or paraprotein. When detected in the urine, this is referred to as a Bence Jones protein. These abnormal proteins are ineffective at combating infections.
The precise cause of multiple myeloma remains unknown, and there are currently no proven avoidable risk factors identified. However, certain factors are associated with an increased likelihood of developing the disease.
Risk factors for multiple myeloma include:
Being over 65 years old.
Men have a slightly higher probability of developing myeloma.
Black people are observed to be twice as likely to develop myeloma compared to white people.
Exposure to radiation increases the risk.
Working in oil-related industry: While some studies suggest this, it has not been definitively proven.
Obesity is associated with increased risk.
Though uncommon, having an immediate relative (parent, brother, or sister) with the disease can increase your risk fourfold.
A history of certain related conditions places you at a higher risk, such as:
Multiple myeloma can be challenging to diagnose early as it often presents with no initial symptoms. When symptoms do appear, they may include:
Myeloma cells can initiate the breakdown of surrounding bone tissue, weakening the bone and making it more susceptible to breaking (Pathological Fracture).
Pain is commonly experienced, particularly in the middle or lower back, rib cage, or hips. The severity can vary based on the extent of the disease.
The disease can lead to a reduction in red blood cells (anaemia), resulting in unusual tiredness or breathlessness upon exertion.
High levels of calcium in the blood or kidney impairment can lead to episodes of confusion. Overly thick blood (hyperviscosity) is another potential cause.
The condition is sometimes linked to compressed nerves, causing numbness in the limbs. Hyperviscosity may also cause weakness or numbness in the face, arms, or legs.
Kidney damage caused by multiple myeloma can impair the body's ability to excrete excess salts and fluids, resulting in swelling.
Decreased appetite, weight loss, and nausea can occur due to high blood calcium levels or kidney failure.
As the cancerous plasma cells crowd out normal infection-fighting white blood cells, the risk of common infections—such as pneumonia, bladder or kidney infections, sinusitis, and skin infections—is increased.
This is typically a result of high blood calcium levels and damage to the kidneys.
As a systemic blood cancer, multiple myeloma can affect various other organ systems, leading to a number of potential complications, including:
A deficiency of red blood cells, which occurs when the abnormal plasma cells displace healthy blood-producing cells in the bone marrow.
A low count of white blood cells, which can weaken the immune system.
Myeloma cells can destroy surrounding bone tissue. Significant bone destruction may appear as bone thinning (osteoporosis) or dark spots (lytic lesions) on X-rays.
High blood calcium levels linked to bone erosion. Calcium stored in the bones is released into the bloodstream, which can negatively affect other body systems.
In some cases, a high volume of M proteins can make the blood thicker, which impedes its smooth flow, especially into smaller blood vessels.
If your symptoms suggest multiple myeloma, your physician will conduct a thorough examination and review your medical history. A combination of the following tests may be used to establish a diagnosis, as well as to monitor the effectiveness of your ongoing treatment:
Following a multiple myeloma diagnosis, your doctor will discuss the optimal treatment plan, which is always tailored to your specific needs. The approach depends on various factors, including the cancer's type, stage, and your overall health. One or more of the following therapies may be recommended to manage the myeloma or help alleviate symptoms:
This approach, which involves closely monitoring the multiple myeloma without active treatment, may be suitable for patients with asymptomatic myeloma (smouldering myeloma) or monoclonal gammopathy of undetermined significance (MGUS).
This is often the initial step in treating multiple myeloma. It involves using specialised drugs to destroy fast-growing cells, such as myeloma cells. SSCHRC provides the latest and most advanced chemotherapy options.
SSCHRC is one of the cancer centres capable of offering targeted therapies for certain types of multiple myeloma. This category of drugs is designed to specifically attack vulnerabilities in the cancer cells, helping to halt the cancer's growth and spread.
Immunotherapy is one of the innovative targeted treatments available at SSCHRC. This method harnesses your body's own immune system to combat the cancer cells. Methods used in immunotherapy include:
This therapy is valuable for providing prompt pain relief and reducing the risk of bone fractures. It uses a high-energy beam to rapidly destroy cancer cells in a focused area. Radiation therapy is effective for targeting plasma cell tumours in one location (solitary plasmacytoma) and can also help prevent nerve compressions by attacking soft tissue masses of myeloma cells (plasmacytomas).
At SSCHRC, a typical radiation plan for a patient with multiple myeloma involves approximately two weeks of treatment, with five sessions per week. We utilise Computed Tomography (CT) scan-based radiation planning, along with immobilisation devices to ensure minimal patient movement during treatment. Our ultimate goal is to administer effective, safe, and modern radiation therapy while strictly limiting toxicity.
A stem cell transplant (also known as a bone marrow transplant) replaces damaged or diseased bone marrow cells with your own healthy blood-forming cells. The process involves first removing some of your healthy stem cells, followed by high-dose chemotherapy to eliminate the diseased bone marrow cells. Finally, the healthy stem cells are re-introduced to replace the diseased tissue. SSCHRC operates one of the nation's most active and advanced programmes for patients requiring a stem cell transplant.
High levels of abnormal proteins can lead to a thickening of the blood (hyperviscosity). In a plasma exchange, the liquid component of the blood (plasma) is removed and replaced with normal plasma from a healthy donor. This procedure offers rapid relief from symptoms related to increased blood thickness until other treatments can destroy the myeloma cells producing the abnormal protein.