Multiple myeloma is a type of cancer that originates in plasma cells, a type of white blood cell that resides in the bone marrow and is responsible for producing antibodies (proteins that help the body fight infections).
In multiple myeloma, plasma cells become cancerous and multiply uncontrollably, interfering with normal blood cell production and damaging bones. In addition to proliferating uncontrollably, these plasma cells begin to produce an abnormal protein called a monoclonal protein, which can cause organ damage.
Symptoms of multiple myeloma
The symptoms of multiple myeloma can vary significantly from person to person, and some patients may not experience any symptoms in the early stages of the disease. When symptoms occur, they may include:
Fatigue:
persistent feeling of tiredness, even after rest, often related to anemia.
Bone pain:
bone pain, especially in the back, ribs, and hips, which may be constant or intermittent.
Recurrent infections:
increased susceptibility to infections due to decreased production of normal antibodies.
Anemia:
a decrease in the number of red blood cells, which can cause fatigue, weakness, and difficulty breathing.
Kidney problems:
due to kidney damage caused by the monoclonal protein.
Hypercalcemia:
raised levels of calcium in the blood, which can cause nausea, vomiting, constipation, and confusion.
Peripheral neuropathy:
damage to peripheral nerves, which can cause changes in sensation, numbness, tingling, and pain in the hands and feet.
Multiple myeloma staging
Once multiple myeloma is diagnosed, its stage is determined to assess the extent of the disease and guide treatment. The most commonly used staging systems are the International Staging System (ISS) (based on biological markers) and the Durie-Salmon system (DSS) (based on tumor mass and damage caused).
The ISS is a simple and widely used system that is based on the levels of two substances in the blood: beta-2 microglobulin (β2M) and albumin. β2M is a protein found on the surface of many cells, and elevated levels of it may indicate increased disease activity. Albumin is an important protein for the functioning of the body, and low levels may reflect a worse prognosis. The R-ISS system also includes other factors such as tumor genetics and the blood level of LDH, a protein found inside cells; its elevated level may also indicate greater disease activity.
The ISS divides multiple myeloma into three stages:
Stage I: β2M less than 3.5 mg/L and albumin greater than or equal to 3.5 g/dL. This stage is associated with a better prognosis.
Stage II: it does not meet the criteria for Stage I or Stage III. It has an intermediate prognosis.
Stage III: β2M greater than or equal to 5.5 mg/L. This stage is associated with a worse prognosis.
Causes and risk factors of multiple myeloma
The exact cause of multiple myeloma is unknown. Research continues to better understand the factors that contribute to the development of this disease.
Although the exact cause is unknown, several risk factors have been identified that may increase the likelihood of developing multiple myeloma:
Age: the risk increases with age, with most diagnoses occurring in people over 65 years old.
Race: it is more common in people of African descent.
Sex: it is slightly more common in men.
Monoclonal gammopathy of undetermined significance (MGUS): it is a precursor condition in which a small amount of monoclonal protein is found in the blood. Although most people with MGUS do not develop multiple myeloma, they have a higher risk than the general population.
In the treatment of multiple myeloma, it is very important to treat its associated complications to avoid chronic organ damage. If not treated promptly, multiple myeloma can cause a number of complications, including:
Anemia: a decrease in the production of red blood cells can cause fatigue, weakness, and shortness of breath.
Kidney damage: the monoclonal protein can damage the kidneys, which can lead to kidney failure.
Recurrent infections: decreased production of normal antibodies increases the risk of infections.
Bone fractures: multiple myeloma can weaken the bones, increasing the risk of fractures.
Spinal cord compression: the growth of cancerous plasma cells in the spine can compress the spinal cord, causing pain, numbness, and weakness.
It is essential to seek medical attention if you experience any of these symptoms or if you are concerned about your risk of multiple myeloma.
Diagnosis and stages of multiple myeloma
The diagnosis of multiple myeloma involves a series of tests and procedures to confirm the presence of the disease. These may include:
Blood tests: blood tests are performed to detect the presence of monoclonal protein, evaluate the complete blood count, ion and other protein levels, and kidney function.
Urinalysis: 24-hour urine samples are analyzed to detect the presence of monoclonal protein.
Imaging studies: X-rays, magnetic resonance imaging, computed tomography, and positron emission tomography (PET) are used to assess bone damage and detect the presence of tumors.
Genetic testing: genetic testing is performed on cancerous plasma cells to identify chromosomal abnormalities that may influence prognosis and treatment.
Bone marrow biopsy: it is the definitive test for diagnosing multiple myeloma. A bone marrow sample is taken for laboratory analysis to determine the number of cancerous plasma cells present.
Furthermore, the diagnosis of multiple myeloma also seeks to determine its stage and differentiate it from other related conditions, such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (also called asymptomatic or indolent myeloma).
The treatment of multiple myeloma is tailored to each patient and depends on several factors, including the stage of the disease, the patient’s age, and overall health. Treatment options may include:
Chemotherapy: it uses medications to destroy cancer cells. In multiple myeloma, chemotherapy is often combined with other treatments, such as targeted therapy or immunotherapy.
Targeted therapy: it uses drugs that specifically target cancer cells, minimizing damage to healthy cells. Examples of targeted therapies used in multiple myeloma include proteasome inhibitors and immunomodulators.
Stem cell transplantation: stem cell transplantation, also known as bone marrow transplantation, is a procedure that replaces damaged bone marrow with healthy bone marrow. There are two main types of stem cell transplants: autologous (using the patient’s own stem cells) and allogeneic (using stem cells from a donor). Stem cell transplantation may be an option for patients with multiple myeloma at certain stages of the disease. The HM Hospitales group has a Hematopoietic Progenitor Transplant Unit, located in the HM Sanchinarro hospital.
Radiotherapy: radiotherapy uses ionizing radiation to destroy cancer cells. It can be used to treat bone pain caused by multiple myeloma or compression of vital organs and structures by plasmacytomas, which are tumors formed by cancerous plasma cells.
Surgery: surgery is rarely used in the treatment of multiple myeloma, but it may be necessary in some cases to treat complications, such as bone fractures or spinal cord compression.
There is also the option of participating in research studies that evaluate new cancer treatments, clinical trials. Participating in a clinical trial can give patients access to promising treatments that are not yet available to the public. If you are interested in participating in a clinical trial, talk to your doctor.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you may have multiple myeloma, consult a specialist to obtain an accurate diagnosis and a treatment plan tailored to your needs.
Our doctors
Contact and make an appointment with the professionals in this area
